194122

Diyabetli Hastalarda Tükrük Glukoz Seviyelerinin Serum Glukoz Seviyesi ve Glisemik Durum ile İlişkisi

Amaç: Diabetes Mellitus (DM); diş hekimlerinin rutin çalışmalarında sıklıkla karşılaştığı endokrin sistemle ilişkili bir hastalıktır. Bu hastalıkta tükrük örneklerininde aralarında bulunduğu, non-invazif teşhise yönelik uygulamalara doğru bir eğilim vardır. Bu çalışmanın amacı diyabetli hastalar ile sağlıklı kontrollerin tükrük glukoz seviyelerini belirlemek ve bu iki grubun tükrük glukoz seviyeleri ile serum glukoz seviyelerini karşılaştırmak ve Diabetli vakaların oluşturduğu grup ile kontrol grubunun tükrük glukoz seviyesi ile ilişkili glisemik durumlarını,her iki grubunda HbA1c değerlerini göz önünde bulundurarak karşılaştırmak amaçlanmıştır. Materyal ve Metod: Çalışma grubu, 5-75 yaşları arasında 120 diabetik ve 80 sağlıklı kontrol olmak üzere toplam 200 bireyden oluşmaktadır. Bu bireylerden alınan bütün tükrük ve serum örneklerinde; tükrük glukoz seviyesi (SGL), kan glukoz seviyesi (BGL), glikozile hemoglobin (HbA1c) değerleri belirlenmiştir. Kan (serum) ve tükrük glukoz seviyeleri Glukoz Oksidaz Peroksidaz metodu kullanılarak tesbit edilmiştir. Glikozile hemoglobin (HbA1c) değeri ise Ion Exchange Resin yöntemi ile belirlenmiştir. Bulgular: Tükrük glukoz seviyesi, diyabetik grupta kontrol grubuna göre önemli derecede yüksektir. Diyabetik ve kontrol gruplarında tükrük glukoz seviyesi (SGL) ve kan glukoz seviyesi (BGL) değerleri arasında önemli pozitif bir ilişki bulunmuştur. Diyabetik hastalarda tükrük glukoz seviyesi ile HbA1c değeri arasında ve SGL, yaş, cinsiyet ve hastalığın süresi gibi kriterler arasında herhangi bir pozitif ilişki bulunamamıştır. Sonuç: Hindistan populasyonunda en yaygın gözlenen Diabetes Mellitus"un teşhisinde tükrük örneği potansiyel bir teşhis materyali olarak kullanılabilir. Tükrük örneği analizi hastalığın taranması ve takibinde kullanılacak basit ve non-invazif bir yöntemdir. Diabetes Mellitus" un teşhisinde ve gözleminde halen yaygın olarak kullanılan kan testleri, hemofilik hastalarda tekrarlayan ağrılı döküntüler gibi zararlı enfeksiyonları beraberinde getiren komplikasyonlar ve bunlar gibi pek çok dezavantaja sahiptir. Bu nedenle non-invazif tükrük testi kan testlerinin yerini alabilir. Aynı zamanda,tükrük testinin maliyeti de diğer yöntemlere kıyasla daha uygundur.

Anahtar Kelimeler:

Diabetes Mellitus, Tükürük glukoz düzeyi, kan glukoz düzeyi, glikozile.

Salivary glucose levels and its correlation with serum glucose and glycemic status in Diabetics

Purpose: Diabetes mellitus (DM) is an endocrine disease that is frequently encountered routinely by dentists. There is increased interest towards non invasive modes to diagnose this disease, one of which is Saliva. The aim of the study was to determine Salivary glucose levels in diabetic and healthy controls, to determine and compare salivary glucose levels with serum glucose in a group of diabetic subjects and matched controls and to study the correlation of salivary glucose levels and glycemic control status in diabetics and controls as determined by HbA1c values. Material and Methods:-The study sample included 200 subjects, 120 with diabetes and 80 controls aged between 5-75 years. Samples of whole saliva and serum were obtained for determining salivary glucose level (SGL), Blood glucose level (BGL) and glycosylated hemoglobin (HbA1c). Serum and salivary glucose was assayed by use of Glucose Oxidase Peroxidase method. Glycosylated hemoglobin was determined by Ion Exchange Resin method. Results:-Salivary glucose levels were significantly higher in diabetics than in controls. Significant positive correlation was found between SGL and BGL in diabetics as well as controls. No positive correlation was found between SGL and HbA1c, nor was any correlation found between SGL, age, sex, and duration of disease. Conclusion:-Saliva can be used as a routine potential diagnostic tool in assessing diabetes mellitus, the most prevalent among Indian population. It is a simple and non invasive technique in screening and monitoring of this disease. Repeated painful pricks, hazard of getting infections, complications in hemophiliac patients and various other disadvantages that involve the blood tests currently used for diagnosis and monitoring of this widely prevalent Diabetes mellitus disease, can be replaced by non invasive tests involving Saliva, which is also a cost effective.

Keywords:

Diabetes mellitus, Salivary Glucose level, Blood glucose level, Glycosylated hemoglobin,

PDF

___

Greenberg Martin S, Glick Michael, Ship Jonathan A. Burket’s Oral Medicine Diagnosis and Treatment, 11 th edition: 510-16. Chavez Elisa. M, Taylor George W, Borrell Luisa N, and Ship Jonathan A. Salivary function and glycemic control in older persons with diabetes. Oral Med Oral Pathol Oral Radiol Oral Endod 2000;89:305-11.
Ship Jonathan A. Diabetes & oral health: - an overview. J Am Dent Assoc 2003;134;4- 10.
Sashikumar Radhika, Kannan Ranganathan. Salivary glucose levels & oral candidal carriage in type II diabetics. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:706-711.
Amer Shehla, Yousuf Muniza, Siddiqui P.Q.R and Alam Junaid. Salivary glucose concentrations in patients with diabetes mellitus- a minimally invasive technique for monitoring blood glucose levels. Pak J Pharm Sci: 2001;14:33-7.
Dodds Michael W J, Dodds Anne P, Antonio San. Effects of glycemic control on saliva flow rates and protein composition in non-insulin- diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol Oral Endod 1997;83:465-70.
Carda C, Mosquera-Lloreda N, Salom L, Ferraris Maria Elsa Gomez de, Peydro Amando. Structural and functional Salivary disorders in type 2 diabetic patients. Med Oral Patol Oral Cir Bucal 2006;11:E309-14.
Marder M Z, Abelson D C, Mandel I D, Salivary alterations in Diabetes Mellitus. J Periodontol. 1975:567-9
Yavuzyilmaz Ezel, Yumak Omur, Akdoganh Tuncay, Yamalik Nermin, Ozer Nazmi, Ersoy Fugen, Yeniay Ihsan. The alterations of whole Saliva constituents in patients with diabetes mellitus. Australian Dental Journal. 1996;41:193-7
Forbat L N, Collins R E, Maskell G K, Sonksen P H. Glucose concentrations in parotid fluid and venous blood attending a diabetic clinic. J R Soc Med.1981;74:725- 8
Sharon Avigdor, Aryeh Ben Hannah, Itzhak Biran, Yoram Kanter, Szargel Raymonde, Gutman David. Salivary composition in diabetic patients. Journal of Oral Medicine. 1985:40:23-26
Bergman Stewart A, Baltimore MS. Perioperative management of the diabetic patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:731-7.
Mealy Brian L, Oates W Thomas. Diabetes Mellitus and Periodontal Diseases. J Periodontol 2006;77:1289- 1303.
Carolyn Robertson, Andrew Jay Drexler, Anthony T. Vernillo. Update on diabetes diagnosis and management. J Am Dent Assoc. 2003;134;16-23.
Lopez Elena Maria, Colloca Eugenia Maria, Paez Gustavo Rafael, Schallmach Nora Judit, Koss Adriana Myriam, Chervonagura Amalia. Salivary Characteristics of Diabetic Children. Braz Dent J. 2003:26-31.
Darwazeh AMG, MacFarlane TW, McCuish A, Lamey P.J. Mixed Salivary glucose levels and candidal carriage in patients with diabetes mellitus. J Oral Pathol Med. 1991;20:280-3.
Belazi Maria A, Galli-Tsinopoulou Assimina, Drakoulakas Drakoulis, Fleva Alexandra & Papanayiotou Panayiotis. Salivary alterations in insulin- dependent diabetes mellitus. Int J Paediatr Dent. 1998;8:29-33.
Sreedevi, Shashikanth M C, Shambulingappa P. Comparison of serum glucose and salivary glucose in diabetic patients. Journal of Indian Academy of Oral Medicine and Radiology. 2008;20:9-13
Vasoconcelos Carolina Anna U, Soares Maria Sueli M, Almeida Paulo C, Soares Teresa C. Comparitive study of salivary and blood glucosa in type 2 diabetic patients. Journal of Oral science. 2010;52:293-8.
Mahvash Navazesh. Measuring salivary flow, challenges & opportunities. J Am Dent Assoc 2008;139:35-40.
Nakamoto Ichiro, Morimoto Kanehisa, Takeshita Tatsuya, Toda Masahiro. Correlation between Saliva glycated and Blood glycated proteins. Environmental Health and Preventive Medicine. 2003;8:95-9.
Vaziri Bakianian P, Vahedi M, Mortazavi H, Abdollahzadeh Sh, Hajilooi M. Evaluation of salivary glucose, IgA, and flow rate in diabetic patients: A case control study. Journal of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. 2010;7:13-8.
Mehrotra K K, Chawla T N, Quantitative estimation of Salivary Glucose. Journal of the Indian Dental Assosciation. 1968:243-8.
Karjalainen Kaisa M, Knuutila Matti L E, Kaar LisaMarja. Salivary factors in children and adolescents with insulin-dependent diabetes mellitus. Pediatric Dentistry. 1996;18:306-11.
Andelski-Radicevic Biljana, Silvija Mirkovic, Tatjana Todorovic and Obrad Zelic. Changes in the biochemical composition of Saliva in Diabetic Patients. Serbian Dental J. 2006;53:209-16
Borg Andersson A, Birkhed D, Berntorp K, Lindgarde F, Matsson L. Glucose concentration in parotid saliva after glucose/food intake in individuals with glucose intolerance and diabetes mellitus. Eur J oral Sci. 1998;106:931-7.
Englander H R, 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.
Soares MSM, Filho MMVB, Pimentel MJ, Passos IA, Kustner EC. Determination of Salivary glucose in healthy adults. Med Oral Patol Oral Cir Bucal. 2009;14:510-3.
Jurysta Cedric, Bulur Nurdan, Oguzhan Berrin, Satman Ilhan, Yilmaz Temel M, Malaisse Willy J, Sener Abdullah. Salivary Glucose Concentration and Excretion in Normal and Diabetic Subjects. Journal of Biomedicine and Biotechnology. 2009;1-6.
Ben-Aryeh H, Cohen M, Kanter Y, Szargel R, Laufer D. Salivary composition in diabetic patients. J Diabet Complications. 1988;2:96-9.
Campbell M.J.A. Glucose in the saliva of the nondiabetic and the diabetic patient. Archives of oral biology. Volume 10, issue.1965:197-205.
Shannon Ira L. Blood and Saliva Glucose levels in relation to Gingival Health. Journal of the Indian Dental Association. 1973: 299-302. Reuterving C O, Reuterving G, Hagg E, Ericson T . Salivary flow rate and salivary glucose concentration in patients with diabetes mellitus influence of severity of diabetes. Diabetes Metab. 1987;13:457-62. Yazışma Adresi / Address for Correspondence: Dr Vagish Kumar L S Lecturer, Department of Oral Medicine and Radiology, Yenepoya Dental College and Hospital, University Road, Deralakatte, MANGALORE-575018 e-mail: Vagishkumar_12@rediffmail.com geliş tarihi/received :27.09.2013 kabul tarihi/accepted:24.10.2013