THE USE OF SALIVARY GLUCOSE CONCENTRATION AS AN INDICATOR FOR GLYCEMIC CONTROL IN DIABETIC PATIENTS

Abstract

People with diabetes mellitus (DM) have an increased incidence of both microvascular and macrovascular complications. Long-term sequelae of DM may include retinopathy with potential loss of vision and nephropathy leading to renal failure. Hypertension, hyperlipidemia, atherosclerotic cardiovascular disease, peripheral vascular disease and cerebrovascular disease also are common. Some people experience peripheral and autonomic neuropathies such as numbness and tingling of extremities. People with poorly controlled DM also may have impaired wound healing and increased susceptibility to infections (1). Although there are several diabetic complications that may occur in the body, several soft tissue abnormalities have been reported to be associated with DM in the oral cavity. These complications include periodontal diseases (periodontitis and gingivitis), salivary dysfunction leading to a reduction in salivary flow and changes in saliva composition, and taste dysfunction. Oral fungal and bacterial infections have also been reported in patients with DM. There are also reports of oral mucosal lesions in the form of stomatitis, geographic tongue, fissured tongue, oral lichen planus (OLP), lichenoid reaction and angular chelitis (2, 3). In addition, delayed mucosal wound healing, mucosal neuro-sensory disorders, dental carries and tooth loss have been reported in patients with DM (4). The prevalence and the chance of developing oral mucosal lesions were found to be higher in patients with DM compared to healthy controls (5). Dentists have a role in the diagnosis of DM throughout the detection of associated oral complications and they have an opportunity and responsibility to educate patients with DM about the oral complications of the disease, and to promote proper oral health behaviors that limit the risks of tooth loss, periodontal disease and soft-tissue pathologies (6). HbA1c has become the preferred clinical measure of glycaemic control. HbA1c is a measure of the non-enzymatic glycation of adult haemoglobin. The quantities of these glycated hemoglobins are much higher in diabetic patients than in healthy people and are more risky for complications of DM (7). Several studies and researches have been done in order to evaluate the benefit of the use of saliva as a diagnostic tool for some diseases via its analysis which is potentially valuable for children and older adults, since whole saliva can be collected non-invasively, easily and with no special equipments compared with the collection of blood. Saliva needs to be more investigated by researchers to evaluate its benefits to measure glycemic control.