+1 Recommend
1 collections

      To submit your manuscript, please click here

      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Use of Dental Practices for the Identification of Adults With Undiagnosed Type 2 Diabetes Mellitus or Nondiabetic Hyperglycemia: Protocol for a Systematic Review

      , BDS 1 , , , BDS 1 , , BSc (Hons), MSc, PhD 2
      (Reviewer), (Reviewer)
      JMIR Research Protocols
      JMIR Publications
      adults, case-finding, dental, diabetes, nondiabetic hyperglycemia, risk assessment

      Read this article at

          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.



          Type 2 diabetes mellitus (T2DM) is a growing global health burden and is expected to affect more than 590 million people by the year 2035. Evidence exists to demonstrate that dental settings have been used for risk assessment and identification of individuals who may be at high risk for T2DM or who may already unknowingly have the condition.


          This protocol aims to outline the methodology that will be undertaken to synthesize the literature relating to the use of primary care (nonhospital-based) dental services for the identification of undiagnosed T2DM or prediabetes—often termed nondiabetic hyperglycemia—in adult patients.


          This paper outlines the protocol that will be followed to conduct a systematic review and meta-analysis of the available literature. The protocol outlines the aims, objectives, search strategy, data extraction and data management methods, as well as the statistical analysis plan. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines were followed in developing the protocol as were elements of the Cochrane handbook.


          We expect the systematic review to be completed within 18 months of publication of this protocol and expect to see a high degree of heterogeneity in the existing literature.


          This review is of importance as it will synthesize the existing evidence base and inform future studies in the field. Following the publication of the protocol, the review will be registered on Prospective Register of Systematic Reviews. Following the completion of the review, results will be published in a suitable peer-reviewed journal.

          International Registered Report Identifier (IRRID)


          Related collections

          Most cited references4

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          Know the signs and symptoms of diabetes

          Diabetes mellitus is a serious metabolic disease, affecting people of all geographic, ethnic or racial origin and its prevalence is increasing globally1. Burden from this costly disease is high on the low and middle income countries (LMIC) where the impacts of modernization and urbanization have caused marked adverse changes in lifestyle parameters. In 2013, of the estimated 382 million people with diabetes globally, more than 80 per cent lived in LMIC. It was estimated that India had 65.1 million adults with diabetes in 2013, and had the 2nd position among the top 10 countries with the largest number of diabetes. This number is predicted to increase to 109 million by 2035 unless steps are taken to prevent new cases of diabetes1. Primary prevention of diabetes is feasible and strategies such as lifestyle modification are shown to be effective in populations of varied ethnicity2 3. However, for implementation of the strategies at the population level, national programmes which are culturally and socially acceptable and practical have to be formulated which are currently lacking in most of the developed and developing countries. Early diagnosis and institution of appropriate therapeutic measures yield the desired glycaemic outcomes and prevent the vascular complications4. Type 2 diabetes which accounts for 85-95 per cent of all diabetes has a latent, asymptomatic period of sub-clinical stages which often remains undiagnosed for several years1. As a result, in many patients the vascular complications are already present at the time of diagnosis of diabetes, which is often detected by an opportunistic testing. Asian populations in general, particularly Asian Indians have a high risk of developing diabetes at a younger age when compared with the western populations5. Therefore, it is essential that efforts are made to diagnose diabetes early so that the long term sufferings by the patients and the societal burden can be considerably mitigated. Risk factors for diabetes Many studies have shown that awareness about the diabetes and its complications is poor among the general population specially in the rural areas6 7. There is an urgent need to create awareness among the population regarding diabetes and about the serious consequences of this chronic disorder. Epidemiological data from India have shown the presence of a number of risk factors which can be easily identified by simple non-invasive risk scores8 9. The major risk factors are listed in Box 1. Box 1 Major risk factors for type 2 diabetes in Indians Signs and symptoms of diabetes The signs and symptoms of diabetes are disregarded by many because of the chronic progression of the disease. People do not consider this as a serious problem because unlike many other diseases the consequences of hyperglycaemia are not manifested immediately. People are not aware that damage can start several years before symptoms become noticeable. This is unfortunate because recognition of early symptoms can help to get the disease under control immediately and to prevent vascular complications. Warning signs & classic symptoms of diabetes Considering the asymptomatic nature of type 2 diabetes in the early stages, it is essential that the people are educated on its warning signs (Box 2). Box 2 Warning signs of diabetes The classic symptoms of diabetes such as polyuria, polydypsia and polyphagia occur commonly in type 1 diabetes, which has a rapid development of severe hyperglycaemica and also in type 2 diabetes with very high levels of hyperglycaemia. Severe weight loss is common only in type 1 diabetes or if type 2 diabetes remains undetected for a long period. Unexplained weight loss, fatigue and restlessness and body pain are also common signs of undetected diabetes. Symptoms that are mild or have gradual development could also remain unnoticed. Screening test for diabetes A person of Asian origin aged 35 yr or more with two or more of the above risk factors, should undergo a screening test for diabetes. An oral glucose tolerance test (OGTT) is commonly used as the screening test10. Fasting and 2 h post glucose tests can identify impaired fasting glucose (IFG) (fasting glucose >110 - 140- 126 and 2 h glucose >200 mg/dl). If a random blood glucose value is > 150 mg/dl, further confirmation by an OGTT is warranted. Recently, glycoslated haemoglobin (HbA1c) has been recommended as the test for diagnosis of diabetes (>6.5%). Presence of pre-diabetes is indicated by HbA1c values between 5.7 - 6.4 per cent11. Screening for undiagnosed T2DM is recommended at the first prenatal visit in women with above risk factors, using standard diagnostic method criteria. Screening for gestational diabetes (GDM) at 24-28 wk of gestation is recommended in women who do not have previous history of diabetes, as GDM remains assymptomatic11. A history of GDM carries a high risk for developing diabetes. Significance of identifying prediabetes Even prediabetic stages such as IFG and IGT carry high risk for vascular complications such as cardiovascular diseases. The recent estimates by the International Diabetes Federation (IDF)1 indicate that globally there are more than 316 million people (6.9%) with IGT. Among them, more than 70 per cent live in LMIC1. It is also important to note that currently one third of those who have IGT are in the productive age between 20-39 yr and, therefore, are likely to spend many years at high risk of developing diabetes and/or complications of diabetes1. Some persons with prediabetes experience reactive hypoglycaemia 2-3 hours after a meal. This is a sign of impaired insulin metabolism indicative of impending occurrence of diabetes. Therefore, periodic medical check-up in people with such signs or risk factors for diabetes would reduce the hazards involved in having undiagnosed diabetes. It would help improve the health status of a large number of people who otherwise would be silent sufferers from the metabolic aberrations associated with diabetes. Conclusions Awareness about the signs and symptoms and periodic screening especially in the presence of risk factors and warning signs of diabetes, would go a long way in preventing new cases of diabetes by providing an opportunity to intervene at the stage of prediabetes. It is evident that diabetes can be prevented among prediabetic individuals by improvements in physical activity and diet habits. Such strategies will also prevent development of diabetic complications to a great extent. Patient empowerment is vital in diabetes management. This can be done through patient education and sharing information on management and preventive aspects of diabetes.
            • Record: found
            • Abstract: not found
            • Article: not found

            Six-month outcomes in dental patients identified with hyperglycaemia: a randomized clinical trial

              • Record: found
              • Abstract: not found
              • Article: not found

              Uptake of screening for type 2 diabetes risk in general dental practice; an exploratory study


                Author and article information

                JMIR Res Protoc
                JMIR Res Protoc
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                November 2018
                19 November 2018
                : 7
                : 11
                : e11843
                [1 ] School of Dentistry University of Birmingham Birmingham United Kingdom
                [2 ] Department of Health Sciences, University of Leicester Leicester United Kingdom
                Author notes
                Corresponding Author: Zehra Yonel z.yonel@ 123456bham.ac.uk
                Author information
                ©Zehra Yonel, Praveen Sharma, Laura J Gray. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 19.11.2018.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org.as well as this copyright and license information must be included.

                : 6 August 2018
                : 4 September 2018
                : 12 September 2018
                : 14 September 2018

                adults,case-finding,dental,diabetes,nondiabetic hyperglycemia,risk assessment


                Comment on this article