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Dental teams could detect undiagnosed diabetes in more than one million people with new care pathway
Research theme
Oral, intestinal and systemic health People involved
Oral, Intestinal and Systemic Health Theme Lead
Clinical Lecturer Periodontology
Dental teams in the UK may help to detect the early signs of Type-2 diabetes, as new research aims to validate routine screening during oral health check-ups.
Diabetes is one of the most common chronic conditions in Europe and is widely recognised to have a strong link with severe gum disease (periodontitis). An estimated 1 in 3 people living with diabetes remain undiagnosed, with more than 1 million undiagnosed in the UK alone. Left untreated, diabetes can lead to long-term complications or can be life-threatening.
Recognising this link, researchers at the University of Birmingham have secured funding from Haleon, the global consumer health company which owns oral health brands like Sensodyne, Corsodyl and Polident, and the support of the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), to continue the development of a new care pathway for early case detection of Type-2 diabetes and pre-diabetes in high street dental practices.
“This exciting collaboration with Haleon will allow us to determine the actual prevalence of pre-diabetes and Type-2 diabetes.”
Dr Zehra Yonel, co-lead researcher on INDICATE-2
In a study published in 2023, the group at the University of Birmingham comprising Dr Zehra Yonel and Professors Iain Chapple and Thomas Dietrich teamed up with Professor Laura Gray from the University of Leicester to develop a new score called the Diabetes risk assessment in Dentistry Score (DDS), for use by dental teams to detect pre-diabetes and diabetes in dental settings.
As part of a recent pilot study called INDICATE, funded by NIHR and Diabetes UK, the DDS was used in conjunction with a finger-prick test for diabetes, called the HbA1c test. The INDICATE trial, which engaged 13 dental practices and 805 dental patients, found that almost 15% of people walking through dental practice doors perceiving themselves to be healthy, exceeded UK pre-diabetes / diabetes thresholds (≥ 42mmol/mol HbA1c).
Now, thanks to funding from Haleon and NIHR, INDICATE-2 will work with 50 dental practices across England and Scotland to screen more than 10,000 patients and develop a care pathway that could help health services detect and treat many more people with undiagnosed diabetes in the UK.
Dr Zehra Yonel, Clinical Lecturer in Periodontology at the University of Birmingham’s Dental School and co-lead researcher on INDICATE-2, said: “This exciting collaboration with Haleon will allow us to determine the actual prevalence of pre-diabetes and Type-2 diabetes within a larger, more representative population sample and assess the feasibility of scaling this approach nationally. It will explore the patient journey and identify barriers or challenges in the care pathway from oral health professional to general medical practitioner (GP) and back to the dental team.”
Vitally important
Professor Iain Chapple MBE, Professor of Periodontology and Consultant in Restorative Dentistry at the University of Birmingham’s Dental School and co-lead researcher for INDICATE-2, said: “This funding from Haleon is very exciting as it will enable us to validate the 2-step model on patients routinely attending dental practices across the UK, and test onward referral pathways of high-risk patients to their family doctors for diagnosis and treatment”.
Dr. Jason Wong MBE, Chief Dental Officer at NHS England, said: “It is vitally important that medical and dental care pathways become more joined up, to put patients at the centre of all we do. INDICATE-2 is a great example of a study aimed to try and define one such pathway.”
Bas Vorsteveld, Vice President and General Manager Great Britain and Ireland, Haleon, said: “At Haleon, our purpose is to deliver better everyday health with humanity. As part of this, Haleon is proud to support this INDICATE-2 research with the University of Birmingham, working with our global oral heath R&D team based in Weybridge. The study highlights the importance of empowering people to take a more active role in managing their health, and in recognising the vital role of oral health professionals in looking after the nation’s health”.
Adam Sisson, Head of R&D, Oral Health, Haleon, said: “We are delighted to be collaborating with the University of Birmingham and NIHR to help support on this important scientific research. We hope the findings will underpin a new care pathway aimed at proactively identifying and treating more people with diabetes by leveraging the expertise of oral health professionals. The study will also help to draw further attention to the links between our oral and systemic health.”
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Notes for editors
- For media enquiries please contact Tim Mayo, Press Office, University of Birmingham, tel: +44 (0)7815 607 157.
- The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, educators and more than 40,000 students from over 150 countries.
- England’s first civic university, the University of Birmingham is proud to be rooted in of one of the most dynamic and diverse cities in the country. A member of the Russell Group and a founding member of the Universitas 21 global network of research universities, the University of Birmingham has been changing the way the world works for more than a century.
- The University of Birmingham is a founding member of Birmingham Health Partners (BHP), a strategic alliance which transcends organisational boundaries to rapidly translate healthcare research findings into new diagnostics, drugs and devices for patients. Birmingham Health Partners is a strategic alliance between seven organisations who collaborate to bring healthcare innovations through to clinical application:
- University of Birmingham
- University Hospitals Birmingham NHS Foundation Trust
- Birmingham Women’s and Children’s Hospitals NHS Foundation Trust
- Aston University
- The Royal Orthopaedic Hospital NHS Foundation Trust
- Sandwell and West Birmingham Hospitals NHS Trust
- West Midlands Academic Health Science Network
- Haleon (LSE / NYSE: HLN) is a global leader in consumer health, with a purpose to deliver better everyday health with humanity. Haleon’s product portfolio spans five major categories – Oral Health, Pain Relief, Respiratory Health, Digestive Health and Other, and Vitamins, Minerals and Supplements (VMS). Its long-standing brands – such as Sensodyne, Panadol, Otrivin, Polident, Corsodyl and Centrum – are built on trusted science, innovation and deep human understanding.
- About INDICATE-2
The potential care pathway trialled in INDICATE-2 aligns with both national and international guidelines – NHS England’s commissioning standard on dental care[1] for people with diabetes calls for greater integrated working between dental and medical teams and clear care pathways for patients, and in 2022 NICE added periodontal care to diabetes care pathways and calculated sizable economic benefits from managing periodontitis in people with diabetes.
- About the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC)
The mission of the NIHR is to improve the health and wealth of the nation through research. We do this by:
- Funding high quality, timely research that benefits the NHS, public health and social care;
- Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
- Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
- Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
- Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
- Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.
NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.
The National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre translates new scientific discoveries into treatments and diagnostics to improve people’s health in the UK and across the globe. We focus on inflammation, a common feature of many diseases, and work to improve its diagnosis, prevention and treatment. We are part of the NIHR and hosted by University Hospitals Birmingham NHS Foundation Trust in partnership with the University of Birmingham.
About diabetes and the strong link with periodontitis
Diabetes is one of the most common chronic conditions in Europe. At least 64 million adults and around 300 000 children and adolescents are estimated to be living with diabetes in the WHO European Region.
Some types of diabetes can be prevented by targeting risk factors with interventions such as improving nutrition, increasing physical activity, reducing obesity, reducing tobacco use and providing more health-supporting environments.
If diabetes is not diagnosed and managed correctly, life-threatening acute events such as comas can occur, as well as progressive disability from complications of the condition. Important complications of diabetes include blindness from damage to blood vessels in the eye, ulcers, amputations from nerve damage in the feet, and kidney disease. The risk of heart attack and stroke increases up to 4-fold for people living with diabetes.
There is a strong link between diabetes and severe gum disease (periodontitis) which has been highlighted by world leading authorities such as the International Diabetes Federation, National Institute for Health and Care Excellence (NICE), the World Organisation of National Colleges of Family Doctors, the European Federation of Periodontology[9], the Federal Dentaire Internationale (FDI)[10] and many others.
The relationship between periodontal (gum) health and diabetes control and complications is bi-directional – if gum disease gets worse, it can make diabetes harder to control and lead to more complications. On the flip side, if diabetes is not well-managed, it can exaggerate gum inflammation and make it harder to treat.
Periodontitis is often associated with living in more socioeconomically deprived areas, as a result of less stringent oral care routines and less frequent attendance at preventative dental check ups.[13]
