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From dental chair to diabetes care: Patient experience highlights potential of new screening pathway
Research theme
Oral, intestinal and systemic health People involved
Clinical Lecturer Periodontology
Oral, Intestinal and Systemic Health Theme Lead
A patient living with Type-2 diabetes has voiced her support for a new healthcare pathway being developed that would enable high street dental teams to conduct routine screenings for the condition. Ann Christian, 50, from Birmingham, shared her story after a routine oral health check-up revealed alarmingly high blood sugar levels. This discovery prompted her to seek further medical support, ultimately leading to her being prescribed medication to help manage the condition.
Ann’s lived experience comes after researchers at the University of Birmingham secured funding from Haleon, the global consumer health company which owns oral health brands like Corsodyl, Sensodyne and Polident, and the support of the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC). This funding will support the development of a new care pathway for early detection of Type-2 diabetes and pre-diabetes* in high street dental surgeries.
The screening involves a straightforward questionnaire to assess the patient’s diabetes risk, followed by a finger-prick blood test. This pathway could help benefit the one million people in the UK living with undiagnosed Type-2 diabetes.
38 practices across England have now been recruited to the INDICATE-2 study, and dental teams across the network have now received the green light to commence the risk-assessment process on consented participants from within their practices. Now that patient recruitment is underway in England, the study will expand to include practices in Northern Ireland, Wales and Scotland.
“We’ve received incredibly positive feedback from those patients like Ann who have experienced the advantages of dentists being able to conduct such tests.”
Dr Zehra Yonel, lead researcher on INDICATE-2
‘That’s when alarm bells started to ring’ – Ann’s story
Ann experienced the benefits of this screening first-hand when a routine gum examination by her dentist revealed that her glucose levels were alarmingly high. She said:
“When I was seen by my diabetes nurse the previous autumn, I was told my diabetes was being controlled relatively well by diet. My figures were at an acceptable level.
“The following summer, my dentist did an examination of my gums and discovered that I had very deep pockets with plaque in them. She suggested I have a blood test to see what my glucose levels were. The blood test found out that my blood sugar levels (HbA1c) were in triple figures. That’s when alarm bells started to ring, and it was pretty obvious that controlling my diabetes by diet wasn’t enough.
“It was a bit of a shock when I realised the diabetes had impacted my gum health. I booked an appointment with the diabetes nurse and she took another blood test. At that point I was put on medication to control my diabetes. Since I’ve been on the medication my diabetes has become much better controlled, and the numbers have come down significantly. The impact of controlling my diabetes in a better way has meant that I’ve lost weight and therefore I’ve got more energy, I feel more confident in myself and I just feel happier. My gum health has improved significantly.”
Based on her own experience, Ann is keen to see the new healthcare pathway rolled out across the country. She said:
“I really do think it’s an excellent idea to have dental teams help to identify patients who are at risk of diabetes or who already have diabetes but they’re not controlling it in the best way. I’ve always felt that medical care can be too pigeon-holed. I think this is a fantastic way to improve people’s health in general.”
Dr Zehra Yonel, Academic Clinical Lecturer in Restorative Dentistry at the University of Birmingham’s Dental School, researcher at the NIHR Birmingham BRC and 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. We’ve received incredibly positive feedback from those patients like Ann who have experienced the advantages of dentists being able to conduct such tests. This next step will allow us to further 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.”
Dr. Jason Wong MBE, Chief Dental officer 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.”
Adam Sisson, Head of R&D, Oral Health, Haleon, said:
“We are thrilled to be collaborating with the University of Birmingham and NIHR to support this important scientific research. It’s great to see early momentum, with over 35 practices and more than 100 dentists trained as part of the initiative so far. We hope the findings will underpin a new care pathway that proactively identifies, treats and supports more individuals with diabetes, like Ann, 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.”
*non-diabetic hyperglycaemia.
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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 nine 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
- Health Innovation West Midlands
- Birmingham and Solihull Mental Health NHS Foundation Trust
- Birmingham Community Healthcare NHS Foundation Trust
- About INDICATE
In a study published in 2023, the research 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). - About the NIHR
The mission of the National Institute for Health and Care Research (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 international development funding 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 Haleon
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. For more information, please visit www.haleon.com. - 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[6], National Institute for Health and Care Excellence (NICE), the World Organisation of National Colleges of Family Doctors, the European Federation of Periodontology, the Federal Dentaire Internationale (FDI) 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.
