ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Saliva May Be A Potential New Diagnostic Tool For Diabetes Mellitus due to Correlation Between Salivary Glucose Levels and HbA1c
Clinical Question For patients at risk of developing diabetes mellitus, is a salivary test that measures glucose levels in the saliva as accurate as a blood serum glucose test for the detection of diabetes mellitus?
Clinical Bottom Line Studies show a strong correlation between salivary glucose levels and glycemia/HbA1c, validating the potential use of saliva as a diagnostic tool for diabetes mellitus. This is supported by a meta-analysis of 10 studies and 2 cross-sectional studies. Currently, diagnostic tools such as the iQuickIt Saliva Analyzer for measuring salivary glucose levels at chair side and in daily patient use, are in development stage.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25025218Mascarenhas/2014 9 published peer-reviewed articles and 1 cross-sectional observational study of 45 type II diabetes mellitus patients and 16 non-diabetic adultsMeta-analysis
Key resultsThe authors performed a cross sectional-observational study and then performed meta-analysis of that data plus nine peer-reviewed studies to assess a correlation between salivary glucose and glycemia HbA1c, to determine if saliva can be used as a biomarker and diagnostic tool for the screening of patients with or at risk of developing diabetes mellitus. Findings of the meta analysis, including the data provided by the cross sectional study, suggest that salivary glucose levels are increased in patients with diabetes mellitus and that a correlation does exist between salivary glucose levels and elevated glycemia/ HbA1c values. A stronger correlation was found between salivary glucose levels and glycemic levels (global correlation coefficient, r= 0.49) than with HbA1c levels (r=0.37).
#2) 25294888Gupta/2014200 patients; 100 non-diabetics, 100 type II diabeticsCross-sectional study
Key resultsA significant difference was found between salivary glucose levels of diabetic patients and non-diabetic patients in India (P<.001). A positive correlation was found between whole salivary glucose levels and serum glucose levels for both diabetic patients and non-diabetic patients (P<.001). For diabetic patients, there was also a positive correlation between their salivary glucose levels and HbA1c levels (P<.001).
#3) 26710500Kadashetti/201590 patients total 3 subgroups: Group I BGL of 200mg/dl plus Group II BGL of 130-200 mg/dl Group III BGL below 130 mg/dl (control group)Cross-sectional study
Key resultsThe authors aimed to correlate salivary glucose levels to plasma levels in both diabetic and non-diabetic patients. They included three groups in this study consisting of diabetic patients with blood glucose levels of 200mg/dl or more (Group I), patients with blood glucose levels of 130-200mg/dl (Group II) and a control group of patients with blood glucose levels below 130 mg/dl (Group III). (They found a statistically significant difference in the salivary glucose levels of groups I and II, when compared to group III (p<0.001). A strong correlation between salivary glucose and plasma levels was established among all groups with a statistical significance of (p<.001).
Evidence Search "diabetes mellitus"[All Fields] AND Salivary[All Fields] AND ("glucose"[MeSH Terms] OR "glucose"[All Fields])
Comments on
The Evidence
Validity: The Mascarenhas systematic review and meta-analysis reports that there was a high level of heterogeneity among the included studies, and the authors included their own unpublished data in the meta-analysis. The heterogeneity makes it very difficult to conduct a proper meta-analysis of the available data so these results should be interpreted with caution. The Gupta and Kadashetti studies were well conducted but are only representative of the populations in those geographical areas. Perspective: Although the majority of the research that has been conducted supports a positive correlation between salivary glucose levels and glycemia/HbA1c, further studies must be conducted on potential chair side diagnostic tools and their accuracy.
Applicability Current methods for the detection and monitoring of high blood glucose levels are painful and invasive. Salivary glucose level tests could serve as a valid, non-invasive method for the detection of diabetes mellitus. It would be an easy and inexpensive way screen patients at chair side in a dental office. Although supporting research is promising, the development of such chair side diagnostic tools is still in progress. Perhaps in the near future, dental offices will be able to implement such a diagnostic and monitoring tool to assess patient’s glucose levels prior to invasive dental treatment.
Specialty/Discipline (Public Health) (General Dentistry)
Keywords Saliva, Diabetes Mellitus, Diagnosis, Screening, HbA1c
ID# 3036
Date of submission: 04/26/2016spacer
E-mail castellanosl@livemail.uthscsa.edu
Author Lliliam Castellanos-Castro
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Juanita Lozano-Pineda, DDS, MPH
Faculty mentor/Co-author e-mail pinedaj@uthscsa.edu
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