Baseline Prediabetes, Hyperglycemia, and Incident Dental Outcomes Among Peruvian Formal-Sector Workers: A Retrospective Occupational Cohort Study

Background/Objectives: Early glycemic abnormalities may identify adults at increased oral health risk, but longitudinal evidence from Latin American occupational populations is limited. We evaluated whether screening-based baseline prediabetes and hyperglycemia were associated with recorded incident dental outcomes among Peruvian formal-sector workers. Methods: We conducted a retrospective cohort study using occupational health records from 2013–2021. The primary outcome was a composite incident dental outcome, defined as incident caries or gingivitis; secondary outcomes were incident caries and incident gingivitis separately. Screening-based baseline prediabetes was compared with normoglycemia after excluding diabetes, whereas screening-based baseline hyperglycemia included prediabetes or diabetes and was compared with normoglycemia. Cox proportional hazards models were adjusted for age, sex, occupation type, smoking, and alcohol consumption, with inverse-probability weighted analyses for exposure and follow-up. Results: Among 79,660 workers, 12,049 (15.1%) had longitudinal dental follow-up. After outcome-specific exclusions and glycemic classification, the hyperglycemia analysis included 10,050 workers and 345 composite dental events, and the prediabetes analysis included 9804 workers and 335 events. Prediabetes was associated with higher hazards of the composite outcome (adjusted HR 1.61; 95% CI 1.20–2.17) and incident caries (adjusted HR 1.94; 95% CI 1.42–2.65). Hyperglycemia showed similar associations with the composite outcome (adjusted HR 1.55; 95% CI 1.17–2.05) and incident caries (adjusted HR 1.87; 95% CI 1.39–2.52). No increased hazard of incident gingivitis was observed. Estimates were directionally stable after obesity adjustment and inverse-probability weighting. Conclusions: Screening-based baseline prediabetes and hyperglycemia were associated with higher recorded incidence of dental outcomes, mainly incident caries, among workers with longitudinal dental follow-up. Limited dental follow-up reduces generalizability and may reflect heterogeneous implementation of dental surveillance. Because proportional hazards diagnostics suggested time-varying associations for the composite outcome and caries, Cox estimates should be interpreted as summary associations over follow-up.