Citation Information :
Bhat AR, Meghana IS, Nair KS. Salivary Fructosamine and Its Association with Interleukin-6 in Prediabetic Patients with and without Chronic Periodontitis: A Cross-sectional Study. World J Dent 2023; 14 (4):313-317.
Aim: The present study aimed to evaluate the association between prediabetes with chronic periodontitis utilizing glycated proteins like fructosamine and inflammatory markers like interleukin-6 (IL-6).
Materials and methods: This cross-sectional study was conducted on 36 subjects for a duration of approximately 7 months (between August 2021 and February 2022) screened for random blood sugar (RBS) levels (110–170 mg/dL) and glycated hemoglobin (HbA1C) levels (5.7–6.4%) as prediabetes and were grouped into three groups (n = 12)—group I—systemically healthy with chronic periodontitis; group II—prediabetic with chronic periodontitis; group III—prediabetic without chronic periodontitis. The periodontal health was evaluated by employing bleeding on probing (BOP), clinical attachment loss, Loe and Silness Gingival Index, and pocket depth. Unstimulated whole saliva (UWS) samples were obtained and subjected to enzyme-linked immunosorbent assay (ELISA) for the evaluation of fructosamine and IL-6 levels. Data were analyzed by Statistical Package for the Social Sciences (SPSS) version 2.0.
Results: The intragroup comparison of salivary IL-6 values were highest among group II (52 ± 73) followed by group I (47 ± 71.7), and then group III (17.8 ± 17.8), while the intragroup comparison of salivary fructosamine values were highest among group I (2.4 ± 1.1) followed by group II (2.0 ± 1.1), and then group III (1.7 ± 0.8) which were statistically highly significant. (p < 0.001). Intergroup comparison revealed no significant difference between salivary IL-6 and fructosamine levels. Although mean fructosamine levels tended to be slightly lower in prediabetic individuals without periodontitis, it was not statistically significant.
Conclusion: Considering the alarming prevalence of undiagnosed diabetes around the world and the benefits of early illness detection, it's obvious to notice why diabetes screening with noninvasive markers like salivary fructosamine is so significant.
Clinical significance: Periodontitis may be associated with prediabetes, which is categorized by impaired glucose tolerance. Early detection of diabetes utilizing noninvasive indicators, such as salivary fructosamine, which appears to become more stable with time due to improved stability against microbiological deterioration, may help to reduce the tissue damage caused by the disease. The present study verifies the dentist's involvement and highlights the importance of focusing on chronic periodontitis patients in this situation.
Javed F, Al-Askar M, Al-Rasheed A, et al. Comparison of self-perceived oral health, periodontal inflammatory conditions and socioeconomic status in individuals with and without prediabetes. Am J Med Sci 2012;344(2):100–104. DOI: 10.1097/MAJ.0b013e31823650a7
Goutoudi P, Diza E, Arvanitidou M. Effect of periodontal therapy on crevicular fluid interleukin-1beta and interleukin-10 levels in chronic periodontitis. J Dent 2004;32(7):511–520. DOI: 10.1016/j.jdent.2004.04.003
Lu HK, Chen YL, Chang HC, et al. Identification of the osteoprotegerin/receptor activator of nuclear factor-kappa b ligand system in gingival crevicular fluid and tissue of patients with chronic periodontitis. J Periodontal Res 2006;41(4):354–360. DOI: 10.1111/j.1600-0765.2006.00883.x
Chan CL, Pyle L, Kelsey M, et al. Screening for type 2 diabetes and prediabetes in obese youth: evaluating alternate markers of glycemia–1, 5-anhydroglucitol, fructosamine, and glycated albumin. Pediatr Diabetes 2016;17(3):206–211. DOI: 10.1111/pedi.12258
Danese E, Montagnana M, Nouvenne A, et al. Advantages and pitfalls of fructosamine and glycated albumin in the diagnosis and treatment of diabetes. J Diabetes Sci Technol 2015;9(2):169–176. DOI: 10.1177/1932296814567227
Manjrekar PA, Hegde A, D'souza F, et al. Fructosamine in non-diabetic first degree relatives of type 2 diabetes patients: risk assessor. J Clin Diagn Res 2012;6(5):770–773.
Morenkova SA. Comparative analysis of dependence of saliva sorbitol and fructosamine levels on blood glucose level in patients with diabetes. Biomed Khim 2004;50(6):612–614.
Barasch A, Gilbert GH, Spurlock N, et al. Random plasma glucose values measured in community dental practices: findings from the dental practice-based research network. Clin Oral Investig 2013;17(5):1383–1388. DOI: 10.1007/s00784-012-0825-y
Holmes H, Negi M, Stephen LXG. Diabetic status of patients presenting for dental treatment. S Afr Dent J 2018;73(4):274–277.
Khoury ZH, Illesca P, Sultan AS. Salivary fructosamine as a noninvasive glycemic biomarker: a systematic review. JDR Clin Trans Res 2021;6(4):382–389. DOI: 10.1177/2380084420954354
American diabetes association. 7. diabetes technology: standards of medical care in diabetes-2021. Diabetes Care 2021;44(Suppl 1):S85–S99. DOI: 10.2337/dc21-S007
Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol 1967;38(6):610–616. DOI: 10.1902/jop.1967.38.6.610
Sahibzada HA, Khurshid Z, Khan RS, et al. Salivary IL-8, IL-6 and TNF-α as potential diagnostic biomarkers for oral cancer. Diagnostics 2017;7(2):21. DOI: 10.3390/diagnostics7020021
Abdul Rehman S, Khurshid Z, Hussain Niazi F, et al. Role of salivary biomarkers in detection of cardiovascular diseases (cvd). Proteomes 2017;5(3):21. DOI: 10.3390/proteomes5030021
Ramamurthy NS, Golub LM. Diabetes increases collagenase activity in extracts of rat gingiva and skin. J Periodontal Res 1983;18(1):23–30. DOI: 10.1111/j.1600-0765.1983.tb00331.x
Armbruster DA. Fructosamine: structure, analysis, and clinical usefulness. Clin Chem 1987;33(12):2153–2163.
Monea A, Eremie LY, Bukhari C, et al. Mediators of inflammation as a link between diabetes mellitus and periodontal breakdown. Acta Med Marisiensis 2018;64(1):39–45. DOI: 10.2478/amma-2018-0005
Lalla E, Papapanou PN. Diabetes mellitus and periodontitis: a tale of two common interrelated diseases. Nat Rev Endocrinol 2011;7(12):738–748. DOI: 10.1038/nrendo.2011.106
Kandavel S, Kumar PDM. Association between salivary fructosamine, plasma glycated hemoglobin, and plasma glucose levels among type ii diabetes mellitus and nondiabetic individuals-a cross-sectional study. Eur J Dent 2019;13(3):310–317. DOI: 10.1055/s-0039-1692018
Hong JW, Noh JH, Kim DJ. The prevalence and associated factors of periodontitis according to fasting plasma glucose in the Korean adults: the 2012-2013 Korea national health and nutrition examination survey. Medicine (Baltimore) 2016;95(14):e3226. DOI: 10.1097/MD.0000000000003226
Shimazaki T, Kadowaki T, Ohyama Y, et al. Hemoglobin A1c (HbA1c) predicts future drug treatment for diabetes mellitus: a follow-up study using routine clinical data in a Japanese university hospital. Transl Res 2007;149(4):196–204. DOI: 10.1016/j.trsl.2006.09.008
Kumar A, Pandey MK, Singh A, et al. Prevalence and severity of periodontal diseases in type 2 diabetes mellitus of Bareilly region (India). Int J Med Sci Public Health 2013;2(1):77–83. DOI: 10.5455/ijmsph.2013.2.77-83
Pontes Andersen CC, Flyvbjerg A, Buschard K, et al. Periodontitis is associated with aggravation of prediabetes in zucker fatty rats. J Periodontol 2007;78(3):559–565. DOI: 10.1902/jop.2007.060358
Deedwania PC, Fonseca VA. Diabetes, prediabetes, and cardiovascular risk: shifting the paradigm. Am J Med 2005;118(9):939–947. DOI: 10.1016/j.amjmed.2005.05.018
Maboudi A, Akha O, Heidari M, et al. Relation between periodontitis and prediabetic condition. J Dent (Shiraz) 2019;20(2):83–89. DOI: 10.30476/DENTJODS.2019.44928
