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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 11  |  Issue : 1  |  Page : 25-27

Salivary glucose estimation: A noninvasive method


Department of Oral Medicine and Radiology, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Date of Web Publication19-Feb-2019

Correspondence Address:
Harshada Ragunathan
C – 178, Anandham Apartments, 1st Street, 2nd Avenue, Ashok Nagar, Chennai - 600 083, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_78_18

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  Abstract 


Background: There is an alarming rise in number of people with diabetes mellitus over these years. Oral physicians are more liable to come in contact with a significant number of patients with diabetes mellitus. Due to the lack of early diagnosis and treatment, diabetes is a major cause of death worldwide. While the early diagnosis of diabetes is essential to prevent its complication, the most commonly used diagnostic method is by the detection of glucose level in blood, but the sample collection is invasive and painful. Thus, there arises a need for a noninvasive and painless technique to detect glucose levels. The aim of this study is to estimate the glucose levels in saliva and correlate it with serum glucose. Materials and Methods: The study was conducted in the Outpatient Department of Oral Medicine and Radiology. Forty patients' serum and saliva were collected and the levels were estimated using the glucose oxidase-peroxidasemethod. Results: Data obtained was subjected to statistical analysis using t-test. Highly significant P value (P = 0.00) was obtained between the serum blood glucose and salivary glucose level. A distinct difference was observed in the salivary glucose between the control and diabetic group. Conclusion: Diabetes mellitus is a globally widespread disease. As the salivary collection is easy and noninvasive, in this study, an attempt has been made to diagnose diabetes mellitus by estimating the salivary glucose level in comparison with serum blood glucose level.

Keywords: Diabetes mellitus, glucose oxidase-peroxidase, noninvasive, salivary glucose level, serum glucose level


How to cite this article:
Ragunathan H, Aswath N, Sarumathi T. Salivary glucose estimation: A noninvasive method. Indian J Dent Sci 2019;11:25-7

How to cite this URL:
Ragunathan H, Aswath N, Sarumathi T. Salivary glucose estimation: A noninvasive method. Indian J Dent Sci [serial online] 2019 [cited 2019 May 25];11:25-7. Available from: http://www.ijds.in/text.asp?2019/11/1/25/252516




  Introduction Top


Diabetes mellitus is a group of complex multisystem metabolic disorders charecterized by relative or absolute insufficiency of insulin secretion and concomitant resistance to metabolic action of insulin on target tissues. India is the diabetic capital of the world. Over 62 million have now been diagnosed with diabetes mellitus. Due to delay in the early diagnosis and fear of the disease and investigation, it has become the major cause of death. The usual method of investigation is by venipuncture, which makes some patients to hesitate.

Saliva offers some distinctive advantages. The whole saliva can be collected in a noninvasive way by the individuals with limited training. Diagnosis of disease through the analysis of saliva is potentially valuable for children and older adults as collection of the fluid is associated with fewer compliance problems as compared with the collection of blood.

One of the best two ways to collect the whole saliva is by the draining method in which saliva is allowed to drip off the lower lip, and the other is by spitting method in which the subject spits saliva into a test tube. Saliva moreover contains glucose, amino acids, lipids-like cholesterol, and mono/diglycerides of fatty acid saliva may be useful for the diagnosis of hereditary disorders, autoimmune diseases, malignant and infectious diseases, and endocrine disorders, as well as in the assessment of therapeutic levels of drugs and the monitoring of illicit drug use.[1]

The aim of the present study is to compare the salivary glucose level with serum blood glucose level in individuals with diabetic mellitus and nondiabetic individuals, and the objective of the study is to assess the validity of saliva in diagnosing diabetes mellitus.


  Materials and Methods Top


The study was conducted in the Outpatient Department of Oral Medicine and Radiology, Sree Balaji Dental College and Hospital, Chennai following the inclusion criteria, where the patients with diabetes where considered as case, and nondiabetic were considered as control, and the exclusion criteria are pregnant females, patients with habit of smoking and chewing tobacco, and patients suffering from systemic ailment.

After patients were detailed about the study protocol, a written consent was obtained. Patients were advised to report 1½ h after breakfast for serum and saliva collection. The later was collected by making the patients to rinse his/her mouth with water and were insisted to open mouth for 5 min without swallowing, and about 1 mL of saliva was collected in a sterile container by the suction method. Serum was collected by venipuncture; blood was collected in a sterile container. Both serum and salivary glucose level were estimated using the glucose oxidase-peroxidase (GOD-POD) method. Both serum and salivary glucose levels were estimated using Glucose Oxidase –Peroxidase (GOD-POD) method and the levels are shown in [Table 1] and [Table 2] for both Case and Control.
Table 1: The serum blood glucose level and salivary glucose level of diabetic patients

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Table 2: The serum and salivary glucose level of control group

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(GOD catalyzes the oxidation of glucose into gluconic acid and hydrogen peroxide

Hydrogen peroxide + Phenol + 4 aminoantipyrine = Quinoneimine

Quinoneimine forms a red color complex which is read in a colorimeter and the value is obtained).


  Results Top


A total of 40 patients were selected. Of which 20 were diabetic and 20 were the control group. In diabetes mellitus, out of 20 patients, 9 of them had the serum glucose level of 150–200 mg/dL, 7 had a level of 200–250 mg/dL, and 4 with a level of 300–400 mg/dl and in control group out of 20 patients 13 patients had the serum glucose level below 100 mg/dl and 7 of them with the level of 100–110 mg/dl.

Data obtained from 40 patients was subjected to statistical analysis using t-test and it is shown in [Table 3].
Table 3: Correlation between serum and salivary glucose level

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There is high statistical significance between the serum blood glucose level and salivary glucose level (P = 0.00). A distinct difference was observed in the salivary glucose between the control and diabetic group. The salivary glucose level for control was between 0.1 and 0.7 mg/dl and for diabetic, the level was between 1.0 and 9.6 mg/dl. However, the salivary glucose levels were highly inconsistent with respect to the serum blood glucose levels, i.e., the salivary glucose levels were not consistent with the severity of diabetes.


  Discussion Top


Diabetes mellitus is a globally widespread disease for which various diagnostic devices are now available. However, among the available methods, blood glucose test is taken as the gold standard for diagnosing diabetes, but blood collection is an invasive method.[2]

Saliva is a wonderful marker of early disease detection that leads to more effective diagnosis and treatment or monitor systemic illness, such as diabetes mellitus.[3] The salivary composition may also correspond to the systemic state of the patient rather than the oral health state.[4] Kortuem[5] was the first who noticed the correlation between serum glucose level and salivary glucose level in 1944, followed by Shannon et al.[6] in 1960 and Englander et al.[7] in 1963 and Campbell[8] in 1965.

In this study, the salivary glucose concentrations correlated with the serum glucose level in patients with diabetes mellitus which was in accordance with the study done by Darwazeh et al.[9] Marchetti et al.[10] in their study suggested that the saliva contributes a simple, quick, and noninexpensive method for screening of diabetic autonomic neuropathy. It was observed that salivary glucose level increased with an increase in serum glucose level both in diabetic and nondiabetic in our study, which was in accordance with the findings of the Naik et al.[11] and Abikshyeet et al.[12] A study done by Agrawal et al. indicated that values observed regarding blood and salivary glucose levels were found distinctly different between normal and diabetic patients suggesting that saliva can be used as an index of diabetes mellitus which was similar to the study.[3] In another study conducted Panchbhai[13] to assess the correlation of salivary glucose level with blood glucose level in people with diabetes mellitus showed a significant positive correlation of salivary glucose level.

Glucose, a small molecule can easily diffuse through semipermeable membranes thus increasing the salivary glucose levels, which ultimately results in altered salivary glucose level and greater susceptibility to disease in the oral cavity. Unstimulated whole saliva has been used in the majority of diagnostic studies because generally there is a dilution of saliva, modulation in pH in stimulated saliva.[2]

Conversely, there are studies which have contradicted the correlation between salivary glucose level and serum glucose level because of the threshold mechanisms along the basement membrane which was justified by Shannon et al. and Twetman et al.[7],[14]

Many researches also asserted that salivary concentrations seem to correlate with serum glucose concentration in patients with diabetes mellitus. In this study, glucose concentration in unstimulated whole saliva was analyzed. There was an increase in salivary glucose level when there was increase in serum glucose level. Hence, saliva can be used as a screening method in diagnosing diabetes mellitus.

Reason for highly inconsistent levels of salivary glucose

  1. In the mucous type of saliva, there is an increase in mucus content (mucopolysaccharide and glycoprotein)
  2. In psychological and physical stress, there is an increase in salivary amylase level which results are increase in the breakdown of starch to glucose
  3. Antimicrobial activity increases salivary hydrogen peroxide which leads to over estimation by GOD-POD kit.


Limitation of this study is that it has a small sample size and the composition of saliva changes in different condition and as a result, there will be alteration in the salivary glucose level.


  Conclusion Top


Frequent monitoring of glucose level is required to reduce its complication. The outcome of the present study showed distinct difference was observed between normal and diabetic patients suggesting that monitoring of salivary glucose level can be used as an index of diabetes mellitus. Further studies on large sample size should be done to ascertain the diagnostic valuability of salivary glucose level in the early diagnosis of diabetes mellitus.

Acknowledgment

The authors would like to thank Sri Venkateshwara Diagnostic Center for providing the material for study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chiappin S, Antonelli G, Gatti R, De Palo EF. Saliva specimen: A new laboratory tool for diagnostic and basic investigation. Clin Chim Acta 2007;383:30-40.  Back to cited text no. 1
    
2.
López ME, Colloca ME, Páez RG, Schallmach JN, Koss MA, Chervonagura A, et al. Salivary characteristics of diabetic children. Braz Dent J 2003;14:26-31.  Back to cited text no. 2
    
3.
Agrawal RP, Sharma N, Rathore MS, Gupta VB, Jain S, Agarwal V, et al. Non invasive method of glucose estimation. J Diabetes Metab 2013;4:1-5.  Back to cited text no. 3
    
4.
Gupta S, Sandhu SV, Bansal H, Sharma D. Comparison of salivary and serum glucose levels in diabetic patients. J Diabetes Sci Technol 2015;9:91-6.  Back to cited text no. 4
    
5.
Kortuem GM. Saliva glucose and blood glucose. Am J Clin Pathol 1944;14:70.  Back to cited text no. 5
    
6.
Shannon IL, Prigmore JR, Brooks RA. Glucose concentrations in parotid fluid and blood serum following intravenous glucose loading. Oral Surg Oral Med Oral Pathol 1960;13:1010-2.  Back to cited text no. 6
    
7.
Englander HR, Jeffay AI, Fuller JB, Chauncey HH. Glucose concentrations in blood plasma and parotid saliva of individuals with and without diabetes mellitus. J Dent Res 1963;42:1246.  Back to cited text no. 7
    
8.
Campbell MJ. Glucose in the saliva of the non-diabetic and the diabetic patient. Arch Oral Biol 1965;10:197-205.  Back to cited text no. 8
    
9.
Darwazeh AM, MacFarlane TW, McCuish A, Lamey PJ. Mixed salivary glucose levels and candidal carriage in patients with diabetes mellitus. J Oral Pathol Med 1991;20:280-3.  Back to cited text no. 9
    
10.
Marchetti P, Tognarelli M, Giannarelli R, Grossi C, Picaro L, di Carlo A, et al. Decreased salivary glucose secretory rate: Usefulness for detection of diabetic patients with autonomic neuropathy. Diabetes Res Clin Pract 1989;7:181-6.  Back to cited text no. 10
    
11.
Naik VV, Satpathy Y, Pilli GS, Mishra MN. Comparison and correlation of glucose levels in serum and saliva of patients with diabetes mellitus. Indian J Public Health Res Dev 2011;2:103-5.  Back to cited text no. 11
    
12.
Abikshyeet P, Ramesh V, Oza N. Glucose estimation in the salivary secretion of diabetes mellitus patients. Diabetes Metab Syndr Obes 2012;5:149-54.  Back to cited text no. 12
    
13.
Panchbhai AS. Correlation of salivary glucose level with blood glucose level in diabetes mellitus. J Oral Maxillofac Res 2012;3:e3.  Back to cited text no. 13
    
14.
Twetman S, Nederfors T, Stahl B, Aronson S. Two-year longitudinal observations of salivary status and dental caries in children with insulin-dependent diabetes mellitus. Pediatr Dent 1992;14:184-8.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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