With millions of at-risk people undiagnosed with prediabetes and diabetes, there is a need to identify alternate screening sites for out-of-range glucose values. We examined practical issues and accuracy (relative to high-performance liquid chromatography testing in a laboratory) in the use of the A1cNow point-of-care device for this screening in general practice dental clinics at a large University-based dental college. Health care professionals obtained evaluable readings for only 70% of the subjects, even after 2 attempts, and its use according to manufacturer’s instructions was often challenging in the busy environment of the dental clinic. At thresholds for prediabetes and diabetes established by the American Diabetes Association, sensitivities of the A1cNow kit relative to the HPLC method were 91.9% and 100%, respectively. However, specificities for prediabetes and diabetes were 66.7% and 82.4%, respectively, indicating many false-positive results. A better strategy for diabetes screening may involve a laboratory-based analysis approach that is patient-friendly and provider-friendly, with minimal burden to the dental team.
From the *College of Nursing, New York University; †Center for Advanced Laboratory Medicine, Columbia University Medical Center, New York Presbyterian Hospital; ‡New York University Langone Medical Center; §College of Dentistry, New York University; and ∥VA New York Harbor Healthcare System, Manhattan Campus, New York, NY.
Reprints: Shiela M. Strauss, PhD, College of Nursing, New York University, 726 Broadway, 10th Floor, New York, NY 10003. E-mail: firstname.lastname@example.org.
Conflict of interest and source of funding: Mark S. Wolff has an ongoing board membership on the American Dental Association; has an ongoing consultancy, grants/grants pending, payment for lectures, and past payment for development of educational presentations for Colgate-Palmolive; is employed as a dentist; provides ongoing expert testimony at multiple legal firms; and has had past payment for development of educational presentations at multiple dental institutions. Shiela M. Strauss, Mary Rosedale, and Mark S. Wolff have grants pending at the National Institutes of Health, and Mark S. Wolff has a grant pending at Colgate-Palmolive. This research was funded in part by a grant from the National Institute of Dental and Craniofacial Research of the National Institutes of Health (grant 1R15DE023201) paid to New York University, covering (or having covered) part of the time of Shiela M. Strauss, Mary Rosedale, Caroline Juterbock, Navjot Kaur, Deborah Goetz, Mark S. Wolff, and Dolores Malaspina. Michael A. Pesce, Joe DePaola, and Ann Danoff declare no conflicts of interest.