Undiagnosed Diabetes and
Hypertension in Patients
at a Private Dental Clinic
in Saudi Arabia
Abstract
Mohammed A. Al-Harbi,
BDS
Resident Dentist
Faculty of Dentistry,
King Abdulaziz University
Jeddah, Saudi Arabia
E-mail: alharbi.mohammed@hotmail.com
Basel M. Abozor, BDS
Endodontic Resident
Faculty of Oral and Dental
Medicine
Cairo University
Cairo, Egypt
E-mail: drbasel1@yahoo.com
Mohammad S. Al-
Zahrani, BDS, MSD, PhD
Associate Professor and
Head, Division of
Periodontics
Faculty of Dentistry,
King Abdulaziz University
Jeddah, Saudi Arabia
E-mail: msalzahrani@kau.edu.sa
Vol. 4, No. 8 (Suppl 1)
O
bjective: The aim of this study was to determine the prevalence of un-
diagnosed diabetes mellitus (DM) and undiagnosed hypertension in
a private dental clinic in Saudi Arabia.
M
ethods: A total of 98 consecutive patients provided information
about sociodemographics, history of DM and hypertension,
and the use of antidiabetic and antihypertensive medications.
Random blood glucose (RBG) levels were measured using a glucometer.
Patients with RBG ≥200 mg/dL were classified as having DM. Two blood
pressure (BP) measurements were taken by a nurse; the average measure-
ment was used to determine hypertension classification. Patients with BP
≥ 140/90 mm Hg were classified as hypertensive.
Results: Approximately 12% and 14% of the total sample of patients
had diabetes and hypertension, respectively; of these, 4% had both condi-
tions. The prevalence of undiagnosed DM and undiagnosed hypertension
was 3% and 8%, respectively. Among subjects ≥35 years of age, 27% and
25% had DM and hypertension, respectively, whereas the prevalence of
undiagnosed DM and undiagnosed hypertension was 6% and 11%, re-
spectively, in this age group.
Conclusion: The prevalence of undiagnosed DM and undiagnosed hy-
pertension among our subjects is high, especially among the older age
group. Oral health professionals are advised to use the opportunity pre-
sented at routine dental visits to review and ensure optimum overall patient
health through proper screening, diagnosis, and referral.
Introduction
Diabetes mellitus (DM) and hypertension are chronic diseases that are
becoming increasingly common global health problems that require lifelong
management to decrease morbidity and mortality because of their associ-
ated complications.
Dental Learning / August 2010 1
 strated that untreated hypertension was responsible for
Table 1 Characteristics of Study Subjects
about 28% of incident strokes, one of the leading causes
Variable Number of Percentage of death worldwide.14 Thus, increasing the detection and
patients
improving the management of hypertension might prevent
Gender Male 62 63.3
Female 36 36.7 a considerable proportion of the incident strokes.14
Education Illiterate 14 14.3 Among patients presenting for dental treatment in Saudi
Completed elementary
school 13 13.2
Arabia, limited data exists on the prevalence of undiagnosed
Completed intermediate diabetes and hypertension15; therefore, the goal of this study
school 18 18.4 was to assess the prevalence of undiagnosed DM and undi-
Completed secondary
school 29 29.6 agnosed hypertension in a sample of dental patients.
Completed more than
secondary school 24 24.5
Nationality Saudi Arabian 44 44.9 Methods
Non-Saudi Arabian 54 54.1 This cross-sectional study was conducted at a private
dental clinic in the western region of the Kingdom of Saudi
DM is a disease in which the body either does not pro- Arabia, from which 98 consecutive patients were selected.
duce or respond to insulin. It is considered to be a com- Information about sociodemographics, history of DM and
mon cause of death, and its prevalence has increased hypertension, and the use of antidiabetic and antihyper-
globally.1,2 More than 240 million people worldwide have tensive medication were obtained from the participants.
DM, and it is predicted that this number will double or Random blood glucose (RBG) levels were measured
triple within the next 10 years.3,4 In Saudi Arabia, 23.7% using a glucometer. Patients with RBG ≥200 mg/dL were
of individuals 30 to 70 years of age have DM.5 classified as having DM. In addition, 2 BP measurements
Complications of DM include: 1) diabetic ketoacido- were taken, 5 minutes apart on the right and left arms, by
sis, caused by sustained high blood sugar; 2) nephropathy a nurse using an electric sphygmomanometer (HEM-775;
(diabetic patients are 25 times more likely to develop end- Omron Healthcare Inc). The average measurement from
stage renal disease than nondiabetics)6; 3) neuropathy or the 2 readings was used in the present study. Criteria from
damaged peripheral nerves; 4) delayed wound healing and The Seventh Report of the Joint National Committee on
high susceptibility to infection; and 5) increased suscepti- Prevention, Detection, Evaluation, and Treatment of High
bility to periodontal infection. BP were used for the BP classification.16 Patients with BP
Globally, approximately 26% of the adult population ≥140 mm Hg systolic and/or ≥90 mm Hg diastolic were
has hypertension.7 The prevalence of hypertension in the classified as hypertensive. Data were analyzed using the
Saudi Arabian population is approximately 25%.8,9 Many Statistical Package for Social Sciences, version 16 (SPSS
people are unaware that they have hypertension. Accord- Inc). Means and frequency distributions were calculated
ing to studies conducted in US and Japanese dental for continuous and categorical variables, respectively.
schools, approximately 49% and 20%, respectively, of in-
dividuals with high blood pressure (BP) were not aware Results
of their condition prior to their dental visit.10, 11 Males comprised 63.3% of the total sample, and ap-
Complications of hypertension can include hardening proximately 45% of the total sample was Saudi Arabian
and thickening of the arteries (atherosclerosis), which may (Table 1). The mean age of the study sample was 32 years,
lead to a heart attack, cerebrovascular events (stroke), and approximately 40% of the sample was 35 years of
aneurysm, and renal diseases.12 age or older.
A recent study demonstrated that about 16% of the A history of DM and hypertension was reported by
new cases of end-stage renal diseases in Australia were be- approximately 15.6% and 10.4%, respectively, of the
cause of hypertension.13 Moreover, it has been demon- total sample. The mean RBG level was 133.2 mg/dL.

2 Dental Learning / August 2010 Vol. 4, No. 8 (Suppl 1)

 Table
Table 22 Prevalence of DM, Undiagnosed DM, and Uncontrolled DM Categorized by Demographic Factors

Variable Percentage of Age Gender Nationality

total sample <35 years ≥35 years Male Female Saudi Non-Saudi
History of diabetes 15.6% 2.3% 33.3% 16% 14.8% 17.1% 14.3%
RBG mg/dL ≥200 11.7% 0% 27.3% 12% 11.2% 17.1% 7.1%
Undiagnosed DM* 2.6% 0% 6.2% 4% 0% 5.7% 0%
Uncontrolled DM† 9.1% 0% 21.1% 8% 7.1% 11% 11.4%

DM, diabetes mellitus; RBG, random blood glucose.

*Patients with no history of DM whose RBG is ≥200 mg/dL.
†Patients with history of DM whose RBG is ≥200 mg/dL.

Table
Table 32 Prevalence of Hypertension, Undiagnosed Hypertension, and Uncontrolled Hypertension Categorized by Demographic Factors

Variable Percentage of Age Gender Nationality

total sample <35 years ≥35 years Male Female Saudi Non-Saudi
History of hypertension 10.4% 2% 24.3% 9.8% 11.4% 13.6% 7.7%
Hypertensive* 13.5% 6.7% 25% 13.1% 14.3% 14% 13.2%
Undiagnosed hypertension † 8.4% 6.8% 11.1% 10% 5.7% 9.3% 7.7%
Uncontrolled hypertension ‡ 5.3% 0% 13.9% 3.3% 8.6% 4.7% 5.8%

*Patients with BP ≥140/90 mm Hg.

†Patients with no history of hypertension whose BP was ≥140/90 mm Hg.
‡Patients with history of hypertension whose BP was ≥140/90 mm Hg.

Mean systolic and diastolic BP was 112.6 mm Hg and
77.3 mm Hg, respectively.
The prevalence of subjects in our sample with undiag-
nosed DM and undiagnosed hypertension was 2.6% and
8.4%, whereas the prevalence of uncontrolled DM and
hypertension was 9.1% and 5.3%, respectively. Undiag-
nosed and uncontrolled diabetes and hypertension were
significantly more common among older than among
younger individuals.
As shown in Tables 2 and 3, men had a higher preva-
lence of undiagnosed DM and hypertension (4% and
10%, respectively) than did women (0% and 5.7%).
However, women demonstrated a higher prevalence of un-
controlled diabetes and hypertension (11% and 8.6%, re-
spectively) compared with men (8% and 3.3%).
Discussion
Many people have diabetes or hypertension but are not
aware of their condition, usually because they either do
not have serious symptoms or they have mild symptoms
that have been treated without an appropriate diagnosis.
This is also true with hypertension, which typically has no
symptoms. People usually discover they have these dis-
eases at a later stage, when more severe complications
begin to develop.
In the present study, about 18% of the sample had a
history of diabetes or a high blood glucose level on the
day of the examination. Among subjects 35 years of age
or older, 39% had a high blood glucose level or had re-
ported a history of diabetes. This is higher than the 24%
reported by Al-Nozha and colleagues5 for a similar age
group. This difference could be because of the different
techniques used to assess the blood glucose level in the 2
studies. In the present study, RBG level was used, whereas
fasting plasma glucose was used in the Al-Nozha, et al.
study.
In the present study, approximately 22% of the sub-
jects with high blood glucose were not aware of their con-
dition prior to their dental visit. This is slightly lower than
that reported by Al-Nozha, et al.5, which was approxi-
mately 28%. This difference may be because of increased
healthcare awareness in patients attending private clinics

Vol. 4, No. 8 (Suppl 1) Dental Learning / August 2010 3

in comparison to those from urban and rural areas who
were involved in the Al-Nozha et al. study.
Approximately 19% of the participants in the present
study had hypertension or had reported a history of hy-
pertension. This finding is slightly lower than that re-
ported in a recent survey conducted in Saudi Arabia in
which 24% of the study population had elevated BP.8
Many people have diabetes or
hypertension but are not aware of
their condition, usually because
they either do not have serious
symptoms or they have mild
symptoms that have been treated
without an appropriate diagnosis.
In the present cross-sectional survey, more than 62%
of the subjects with high BP were not aware of their con-
dition before their dental visit. This result is consistent
with a recent report on a sample of female dental school
patients in Saudi Arabia, but higher than that reported in
dental patients in the United States and in Japan.10, 11, 15
It is important to remember that being in a dental clinic
induces anxiety and may lead to a temporary increase in
BP.17,18 In addition, a diagnosis of hypertension cannot be
made based on 1 random reading during 1 visit. Generally
an average of multiple readings during 2 or more visits is
required to establish a diagnosis of hypertension.
The involvement of all healthcare providers in diag-
nosing hypertension and diabetes is highly encouraged.
Furthermore, all healthcare providers, including oral
health professionals, need to encourage their patients with
diabetes and hypertension to comply with prescribed
treatment. The roles of oral health professionals in the di-
agnosis and management of diabetes and hypertension is
important, as they can be the first to detect such diseases
or their complications.11
Conclusion
The prevalence of undiagnosed DM and undiagnosed
hypertension is high in the present sample, especially
4 Dental Learning / August 2010
among the older age group. Oral health professionals are
advised to use routine dental visits to review and ensure
optimum overall patient health through proper screening,
diagnosis, and referral. Oral healthcare providers can be
the first to diagnose these diseases and should therefore
be knowledgeable about diabetes and hypertension. Rou-
tine screening tests for diabetes and hypertension per-
formed in dental clinics can lower the chances of
complications associated with these diseases during or
after dental treatments.
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