High prevalence of undiagnosed hyperglycemia and cardiovascular risk in dental clinics: evidence from a large retrospective study in China

Objectives: This study aimed to assess the high prevalence of undiagnosed hyperglycemia and associated cardiovascular disease (CVD) risk among dental patients, and to explore the potential role of dental clinics as a key setting for early detection of undiagnosed or poorly controlled hyperglycemia, periodontitis, and elevated CVD risk. Methods: A 10-year retrospective cohort study was performed involving 40,136 patients who received dental care between 2015 and 2024 for FPG level analysis. A matched subcohort of 1,461 patients with complete clinical data was selected for detailed analysis including FPG, diabetes awareness, periodontal evaluations, and coagulation profiles. Participants were divided into three groups based on ADA criteria: normal FPG (3.9– < 5.6 mmol/L), impaired fasting glucose (IFG, 5.6– < 7.0 mmol/L), and abnormal FPG ( ≥ 7.0 mmol/L). Relationships were assessed between FPG, diabetes awareness, periodontal severity, and CVD risk through appropriate statistical tests. Results: In our sample, the prevalence of IFG reached 30.2% and abnormal FPG in 14.0% of cases, which significantly exceeded national estimates in China. Notably, over 96% of those with IFG and about 52% with abnormal FPG in subcohort had never received any diabetes-related diagnosis before. Around 60% with a confirmed diabetes diagnosis still had uncontrolled FPG levels. Higher FPG showed a clear positive association with worse periodontal status (p < 0.05). Coagulation markers differed noticeably depending on both glycemic control and periodontal severity, and patients with advanced periodontitis faced elevated CVD risk (p < 0.05). Conclusions: Dental patients carry a high burden of undiagnosed hyperglycemia and elevated cardiovascular risk. Dental clinics represent a valuable frontline setting for the early identification of undiagnosed or uncontrolled hyperglycemia and concurrent CVD risk. Clinical significance: Periodontitis is a critical risk factor for abnormal FPG and CVD risk in dental patients. Dental clinics can serve as pivotal platforms for oral-systemic comorbidity prevention and management by implementing FPG screening and establishing cross-disciplinary referral systems, which helps address the high rate of undiagnosed hyperglycemia and improve holistic patient health outcomes.