salivary glucose leveis

8/3/2019 Salivary Glucose Leveis

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INFLUENCE OF SALIVARYGLUCOSE ON THE GROWTHOF CANDIDA ALBICANS IN

TYPE I AND TYPE IIDIABETES


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iabetes mellitus(DM) is a complex multisystemic metabolicisorder characterized by a relative or absolute insufficiency of

sulin secretion and/or concomittant resistance to metabolicction of insulin on target tissues.lobally 180 million people are estimated to have DM.his metabolic disorder is a burden on both patient and society

ecause of the high morbidity and mortality associated withfections, and renal,retinal and vascular complication.


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CLASSIFICATION

Etiologic classification of Diabetes mellitus(as perAmerican Diabetes Association)1.Type I Diabetes Mellitus(10%) [ called as insulin

dependent or juvenile-onset diabetes] Type II Diabetes Mellitus(80%) [called as non insulindependent or maturity onset diabetes]

Other specific types of Diabetes(10%) Disease of exocrine gland like pancreas(e.g. chronic

pancreatitis etc.) Endocrinopathies(e.g. acromegaly etc.)4. Gestational Diabetes


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o Diabetes has variable and sometimes profound, effects onthe oral tissues.

o Patients with poor glycemic control are particularly prone tsevere and /or recurrent oral infections.

o

Oral candidiasis, in particular, is reported to be moreprevalent among these individuals.

o The frequent occurrence of Candidal infections in patientswith diabetes mellitus has been recognized for many

years.


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The carriage of Candida in the oral cavity of diabetic

subjects is claimed to be higher. The candidal density has also been reported higher indiabetes mellitus than in non-diabetic subjects

Primary prevention of the disease and the prevention ofdiabetic complications are of great practical importance.


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AIM AND OBJECTIVES

The present study was undertaken to estimate theprevalence of Candida carriage and their colonization inoral cavity of diabetic subjects and made an attempt tofind the relationship of oral carriage of Candida indiabetics with their degree of diabetic control and withnormal patients.


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DIAGNOSTIC CRITERIA FOR DIABETES

o For this study 2 ml peripheral venous blood was collectedfrom every patient.

o RNFPG level were measured using glucose oxidasemethod.

o Subjects with RNFPG>140 mg/dl were diagnosed asdiabetics.

o Subjects with RNFPG between 70-140 mg/dl wereconsidered as non diabetics.


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MATERIALS AND METHODS

o

The study population included diabetic patients (n=30) andnon diabetic/ contolled patients(n=30) attending the OPDof Department of oral and maxillo-facial pathology.

o Verbal consent was obtained from every individual

participating in the study.


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The subjects were divided into 3 groups:

1.group 1 was controlled diabetics n=15 who were beingtreated for diabetes and had random non fastingplasma glucose(RNFPG) values>140mg/dl and200mg/dl;

group 3 were selected as non diabetics/controlledpatients n=30 composed of non diabetic patients with

RNFPG 70-140mg/dl.


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SALIVA COLLECTION

o Patient were asked to have their breakfast and to abstainfrom eating for 2 hours before the sample collection

o Unstimulated saliva was collected using ''spit technique''o The patient was asked to sit in the chair with the head tilted

forward and instructed not to speak, swallow, or do any heamovement.

o Then the patient was instructed to spit in a sterile graduatedcontainer every minute for 3 minutes.


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Glucose level of unstimulated saliva was measuredusing glucose oxidase method in a semi automatedanalyzer.

The saliva sample(100 microleter) was mixed with thereagent in 1:3 ratio and incubated for 5 minutes at 37degree Celsius.

The absorbance value of standard and the sample againstthe reagent blank was measured.

The glucose standard was diluted 10 times for estimationof salivary glucose levels.

MEASUREMENT OF SALIVARYGLUCOSE LEVEL


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SALIVA SAMPLING AND ASSESSMENT OF

SALIVARY YEAST COUNT

Saliva sampling for estimation of colony forming unit(CFUs)of candida was performed using oral rinse technique.

All subjects rinsed their mouth for 60 seconds with 10 mlsterile phosphate-buffered saline.

Each subject returned the rinse to a sterile container.


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The rinse was immediately concentrated by

centrifugation at 2000rpm for 10 minutes. The supernatant was discarded and .001 microliter

deposits was collected and was spread using inoculatingloop onto Sabouraud dextrose agar plates supplemented

with chloramphenicol. CFUs were counted manually and the number wasmultiplied by 1000 and expessed as CFU/ml


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MODEL R R SQUARE STD. ERROR OF

ESTIMATE

a 0.63 0.397 1799.292

b 0.859 0.738 1774.256

c 0.835 0.697 589.243

STATISTICAL ANALYSIS

LINEAR REGRESSION ANALYSIS


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Groups Controlleddiabetics(a)

Uncontrolleddiabetics(b)

Non diabetics/control (c)

Number of patients 15 15 30

Range of salivary glucose 1-18.9 1.5-25.6 .2-7.7

average of salivary glucose 11 21 3

*CFU range 200-8000 100-25000 100-5000

Average of CFU 2223.33 9553.33 1210.5

*CFU -colony forming unit

RESULTS


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RESULTS

Salivary glucose level was significantly higher in diabeticsubjects than in non diabetic subjects.

The median (range) of unstimulated salivaryglucose(USSG) level was highest in group 2 [21mg/dl(1.5-25.6mg/dl)] followed by group 1 [11mg/dl (1-18.9mg/dl)] and group 3 [3mg/dl(.2-7.7mg/dl)].

Significant differences in USSG between all groups wasobserved.


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Increase in salivary glucose level was directly relatedwith increase in candida carriage more in uncontrolleddiabetic patients than in controlled diabetic and nondiabetic patients

The median(range) CFU was significantly higher ingroup2 [9553CFU/ml(100-25000)] than in group 1

[2223CFU/ml(200-8000)] and group3 [1210CFU/ml(100-5000)]


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DISCUSSION

Detected salivary glucose level was significantly higher indiabetic subjects(group2>group1) than in non diabeticsubjects(group3).

This increase in salivary glucose level with increase in

blood glucose level has been suggested to be attributed toleakage across the basement membrane of the salivaryglands, particularly the Parotid gland when blood glucoselevel increase beyond a threshhold value.


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Analysis of salivary glucose level shows a positive

correlation between glucose level and RNFPG inuncontrolled diabetics subjects , not in non diabeticsubjects and control diabetic subjects.

Candida CFUs were significantly higher in diabetic

subjects (group2>group1) compared with non diabeticsubjects (group3)


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Candida CFUs were significantly higher in diabetic

subjects (group2>group1) compared with non diabeticsubjects (group3)

There was a significant positive correlation betweensalivary glucose and CFU of candida.

High level of salivary glucose increase candidaladherence to buccal epithelial cells.


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CONCLUSION

Increase in salivary glucose is suggestive of increase incandida carriage suggesting diabetic status and pronenessfor infections.

salivary glucose leveis

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