Diabetes mellitus is a metabolic disorder characterised by elevated blood glucose levels (hyperglycaemia) due to insulin deficiency or insulin resistance . Diabetes is considered a significant global health issue [2, 3] and is referred to as the world’s largest non-communicable epidemic [4, 5]. The global prevalence of diabetes was 8.5% in 2014 , and it is predicted that approximately 700 million people will be living with diabetes by 2045 . In Australia, around 1.2 million individuals are diagnosed with diabetes, with more than 10,000 new cases identified every year . The economic burden of diabetes to the Australian economy is estimated to be over $6 billion annually .
Chronic and poorly managed diabetes affects an individual’s cardiovascular, renal, optical, neurological and oral health . The relationship between diabetes and oral health is significant  with a bidirectional link between hyperglycaemia and periodontitis (advanced periodontal disease) . Specifically, periodontitis can adversely affect diabetes management as periodontitis is linked to an increase in glycated haemoglobin (HbA1C) . Individuals with poorly managed diabetes are up to three times more likely to develop periodontitis than individuals without diabetes  and are also at an increased risk of dry mouth, tooth decay, tooth loss, oral thrush and taste impairment . Systematic reviews and meta-analyses suggest that a significant reduction in HbA1C ranging from 0.3–0.7% [13–17] is observed among individuals with diabetes who have received periodontal treatment.
Despite the literature providing evidence detailing the importance of oral health in diabetes management, studies suggest that there is a gap in oral health knowledge, attitudes and practices among people with diabetes. One systematic review found that individuals were generally not aware of the relationship between diabetes and oral health . Furthermore, attitudes towards oral health, as well as compliance with the recommended oral hygiene practices and dental visits were poor . Impaired oral health is already known to affect quality of life . Individuals with diabetes who also experience mouth pain, xerostomia, halitosis and periodontitis, report lower oral health-related quality of life (OHQoL) and overall health-related quality of life compared to people without diabetes . Nevertheless, there is evidence to suggest that people with diabetes are receptive to advice about oral health from diabetes care providers such as diabetes educators and general practitioners (GPs) [18, 21].
The role of diabetes care providers, particularly diabetes educators, is to provide guidance and education on the management of diabetes . Current clinical practice guidelines for the prevention and management of diabetes also recommend the integration of an oral health review and referral by diabetes care providers [23–25]. Diabetes care providers are therefore ideally placed to address the gaps in knowledge and behaviours with respect to oral health among clients. However, there are significant barriers to diabetes care providers undertaking this role which include lack of training in this area, time constraints, lack of appropriate oral health referral pathways as well as limited oral health promotional resources and screening tools [2, 22].
Over the years various strategies have been implemented in Australia to support diabetes care providers to promote oral health. These have included professional development oral health training programs, tailored evidenced based resources for people with diabetes and government schemes to improve access to oral health services [26–28]. To further assist diabetes care providers in referring clients to oral healthcare professionals, recent needs assessment studies (involving diabetes educators and GPs) in Australia [2, 22] revealed the need for a short, non-invasive oral health screening tool. Shorter screening tools have been developed for non-dental professionals in other settings. A short two-item oral health screening tool was developed by George et al.  for midwives to screen and refer pregnant women to the dentist. This validated tool was found to have high sensitivity (up to 94%) , and was easily administered by midwives . Nijland et al.  also developed an 8-item screening tool for medical professionals to screen for periodontitis, although it had a comparatively lower sensitivity (49%). Among people with diabetes, however, there are currently no short, screening tools available to screen for risk of poor oral health. Validated tools such as the 21-item Diabetes Oral Health Assessment Tool (DiOHAT)  and the 17-item modified DiOHAT  have been identified as difficult to incorporate into practice due to their length and time constraints. The aim of this study, therefore, was to develop and pilot a short oral health screening tool for diabetes care providers.