Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Dr. Saumya Navit

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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : ZD11 - ZD15 Full Version

Comparative Evaluation of the Efficacy of Gingival Crevicular Blood with Finger Capillary Blood and Venous Capillary Blood to Assess Blood Glucose Levels for Screening of Diabetes Mellitus in Chronic Periodontits Patients: A Cross-sectional Study


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/59578.17223
Chandni Patel, Vallari Shah, Bela Dave, Sapan Patel, Shreya Gajjar, Tanvi Hirani, Gaurav Girdhar, Surabhi Joshi

1. PhD Scholar, Department of Periodontics, Gujarat University, Ahmedabad, Gujarat, India; Senior Lecturer, Department of Periodontics, Karnavati University, Gandhinagar, Gujarat, India. 2. Postgraduate Student, Department of Periodontics, Karnavati University, Gandhinagar, Gujarat, India. 3. Professor and Head, Department of Periodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India. 4. Professor, Department of Periodontics, Karnavati University, Gandhinagar, Gujarat, India. 5. Senior Lecturer, Department of Periodontics, Karnavati University, Gandhinagar, Gujarat, India. 6. Reader, Department of Periodontics, Karnavati University, Gandhinagar, Gujarat, India. 7. Senior Lecturer, Department of Periodontics, Karnavati University, Gandhinagar, Gujarat, India. 8. Professor and PhD Scholar, Department of Periodontics, Karnavati University, Gandhinagar, Gujarat, India.

Correspondence Address :
Dr. Chandni Patel,
PhD Scholar, Department of Periodontics, Gujarat University,
Ahmedabad, Gujarat, India.
E-mail: chandnipatel.dr@gmail.com

Abstract

Introduction: Diabetes mellitus is defined as a clinically and genetically diverse cluster of illnesses involving conflict in carbohydrate and protein metabolism. Periodontitis is a complex condition with several causes. The interaction between these two conditions appears to be cyclical as well as bidirectional. Gingival crevicular blood obtained through routine periodontal oral assessment could be utilised for blood glucose estimation.

Aim: To examine the efficacy of gingival crevicular blood elicited during routine periodontal probing, as a reliable source for screening of diabetes mellitus, and to compare it with finger capillary blood and venous capillary blood in chronic periodontitis patients.

Materials and Methods: This cross-sectional, in-vivo, clinical study was conducted in the Department of Periodontology at Karnavati School of Dentistry, Gandhinagar, Gujarat, India, from January 2021 to January 2022. The study included 50 patients, who were diagnosed with chronic periodontitis in the age range ≥30 years, and met the inclusion and exclusion criteria. A prior detailed history was compiled. The clinical parameters recorded were sulcus bleeding index, plaque index, gingival index, probing pocket depth, and clinical attachment level. Each patient’s blood samples were collected from three different sites, Gingival Crevicular Blood (GCB) collected from gingival crevice, Finger Capillary Blood (FCB) collected from finger bed and and Venous Capillary Blood (VCB) collected from forearm for determining the blood glucose levels. Glucose levels were compared by one-way Analysis of Variance (ANOVA). Karl Pearson’s correlation was used for the comparison. Statistical Package for Social Sciences (SPSS) version 26.0 was used for statistical analysis and p-value ≤0.05 was considered as statistically significant.

Results: The mean Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL) was 5.5±0.61 mm and 6.76±0.82 mm, respectively. The mean Plaque Index (PI) and Gingival Index (GI) score was 1.41±0.25 and 1.45±0.21, respectively. The mean GCB, FCB, and VCB glucose level of the subjects were 171.58±85.63 mg/dL, 179.14±80.31 mg/dL and 186.96±87.57 mg/dL, respectively. There was no statistical difference seen among the three methods, thus, either of the methods can be used for measuring blood glucose levels for screening of diabetes mellitus in chronic periodontitis patients (p-value=0.66). Posistive correlation between FCB and VCB (r-value=0.976, p-value <0.001). VCB and GCB, when correlated showed strong positive and highly statistically significant results (r-value=0.934, p-value <0.001). Similarly, GCB and FCB showed a positive correlation (r-value=0.920, p-value <0.001) which was statistically highly significant.

Conclusion: The results suggested that, the efficacy of gingival crevicular blood when compared with finger capillary blood and venous capillary blood glucose levels showed positive correlation, suggesting either can be used in dental clinics for diabetic screening purpose without any extra invasive procedures.

Keywords

Diagnostic aid, Glucometer, Glycated haemoglobin, Non invasive, Screening tool

Diabetes Mellitus (DM) is one of the world’s most commonly occurring epidemic diseases. It is heterogeneous, with the common feature of impaired glucose tolerance with altered lipid and carbohydrate metabolism (1). Diabetes mellitus puts a significant strain on the healthcare system. Diabetes is becoming more common all across the world, particularly in India (2).

Diabetes was responsible for 10.7% of all deaths in people aged 20 to 79 in 2017, with approximately four million deaths attributed directly or indirectly to diabetes or high blood glucose (3). It is the world’s fastest growing chronic condition, on track to become the sixth leading cause of death by 2030, according to predictions (3).

Also, more than 50% of diabetic patients go undiagnosed. The classic complications of diabetes mellitus i.e. retinopathy, neuropathy, nephropathy, macrovascular disease, altered wound healing and periodontitis which has been added as a sixth complication. Severity of periodontitis and its incidence is markedly influenced by DM and also various strong evidences have shown the same (4). A close inter relationship exist between the two signifying that they both are associated with advancing age, are asymptomatic with a bidirectional relationship.

Diabetic screening at the dental office is usually done based on the patient’s medical history and symptomatic analysis, but it has drawbacks, such as a lack of precision, objectivity, and the ability to detect diabetes early (5). Also, diabetics on rigorous treatment regimens or long-term dental therapy are more likely to be hypoglycemic during dental treatment. As a result, it is a dental practitioner’s job to do diabetic screening and rule out undetected diabetes for specific physical issues, which could affect the treatment approach.

Dentists can diagnose and relate periodontal disease and other oral manifestation of DM that many physicians may find it less familiar and difficult to relate to (6). Blood samples required to test blood glucose may be obtained within the mouth from the gingival crevicular area during routine periodontal examination (7). This gives a unique opportunity for Oral Health Program (OHP) in screening for DM. Other advantages include previous experience of treating patients with medical condition that puts OHP in a bright spot for screening systemic condition like DM and Cardiovascular Disease (CVD) (8).

A field trial, utilising invasive and non invasive risk test carried out for screening DM in different dental settings in Rhodes Island, had identified little over 12% of patient diagnosed with DM and another 23% at high risk of developing the disease among the 45 year and older patients, who were unaware of the DM status at the time of presentation but later diagnosed with DM (within a year of follow-up) and prediabetes (9).

As a result, early identification of diabetes in its early stages is a top goal in healthcare. To avoid this potentially unfavorable life situation, appropriate screening devices and standardised methods are essential (10). Despite the fact that the finger-prick method is a non invasive approach for measuring blood glucose directly and accurately. The conventional laboratory methods such as that are employed to screen for diabetes are time consuming and necessitates elaborative equipment. The advent of blood glucose monitors allows the clinicians to assess blood glucose levels at the chair side. Since, periodontal disease and diabetes are closely associated, it is likely that dentists and more so periodontists would encounter several diabetics, many of whom could be undiagnosed. Screening such patients in dental office itself could hence be beneficial (11). Patients with undiagnosed diabetes mellitus are at greater risk for complications like coronary heart disease, stroke and peripheral vascular disease. The American Diabetes Association recommends that diabetes screening should begin at 45 years of age and be repeated every three years in and sooner and more frequently in people with risk factors such as diabetes (12). The basic laboratory measures for screening includes fasting blood glucose, glucosuria, Haemoglobin A1c (HbA1c) and Oral Glucose Tolerance Test (OGTT) (13).

The best indicator for estimating diabetes prevalence and incidence is Fasting Plasma Glucose (FPG) which is used commonly. Fasting plasma glucose concentration of >7.0 mmol/L (>126 mg/L) is an indication for retesting. For centralised screening the analysis of HbA1c from a blood drop is recommended, though this approach is more expensive than FPG (13). The conventional laboratory methods used for blood glucose detection are more time consuming and require elaborate equipment in contrast to the modern blood glucose monitors which enable clinicians to perform allow chair side assessment of blood glucose (11).

The present study was conducted to examine the efficacy of gingival crevicular blood elicited during routine periodontal probing as a reliable source for screening of diabetes mellitus, and to compare it with finger capillary blood and venous capillary blood in chronic periodontitis patients.

Material and Methods

This cross-sectional, in-vivo, clinical study was conducted in the Department of Periodontology at Karnavati School of Dentistry, Gandhinagar, Gujarat, India, from January 2021 to January 2022. The Karnavati School of Dentistry’s research review board committee gave their approval to the study (KSDEC/20-21/Apr/010). Patients were selected from the Outpatient Department of Periodontics. Total 50 patients were who were diagnosed with chronic periodontitis with age ≥30 years and who met the inclusion and exclusion criteria were included in the study. Prior to the start of the study, each subject was told about the protocol and gave their informed consent. After obtaining the informed consent, study procedures were performed.

Sample size calculation: The sample size was calculated using the following formula:

N=(Za)2(S)2/(d)2

Where,

Za=1.96 (assuming the distribution was normal and confidence limit was 95%)
S=Anticipated from pilot study=35 (A pilot study was done on 10 patients before the start of the study, where standard deviation of 35 mg/dL was observed).
d=Minimum difference to be detected=10

Substituting the values in the formula, Sample size (n) was calculated to be 47.04. Hence, final sample size was 50.

To evaluate their daily routine, mood, and responsiveness, they were asked a series of routine questions. The routine questions included their daily life style regarding daily schedule, diet, habits like smoking and sleeping cycle as they directly or indirectly affects blood glucose levels. Blood samples were obtained from three different locations for each individual prior to any therapy.

Inclusion criteria: Patients with diagnosis of chronic periodontal disease based on criteria proposed by World Workshop on Periodontology, 2017 (14), thus, periodontal disease with presence of interdental Clinical Attachment Loss (CAL) at ≥2 non adjacent teeth, or buccal or oral CAL ≥3 mm with pocketing >3 mm was detectable at ≥2 teeth. Patients having atleast 20 teeth present in upper and lower jaws and those who gave an informed consent to participate were included in the study.

Exclusion criteria: Patients diagnosed with bleeding disorders like platelet function defects such as Von Willebrand disease, purpura, haemophillia were excluded from the study. Patients taking medication interfering with the coagulation system such as aspirin and warfarin and patients undergoing treatment of anaemia, polycythemia, gout, dialysis or any other disorder, that can cause abnormal variation in the haematocrit were also excluded from the study.

Study Procedure

A detailed case history was compiled. The clinical intraoral examination was done in a dental chair with diagnostic tools including a mouth mirror tweezers, a straight explorer, a UNC-15 probe and a William’s probe by Qulix™ from Hu-Friedy group single-ended, colour-coded ergonomic handle with normal illumination. The clinical parameters recorded were Sulcus Bleeding index (Mulhemann HR and Son S, 1971) (15), Plaque Index (Loe H and Silness J, 1963) (16) Gingival Index (Loe H and Silness J, 1963) (16). Using a Williams’s periodontal probe, the Periodontal Pocket Depth (PPD) from the gingival margin to the bottom of the gingival sulcus was measured. The clinical attachment level measured from Cementoenamel Junction (CEJ) to the base of the pocket was measured with the UNC-15 periodontal probe. The study participants underwent history taking, complete clinical and periodontal examination and blood investigations by single examiner only.

After history taking and periodontal examination patients with chronic periodontitis were made sit on chair side in-office blood sample estimation for blood glucose levels from:

• Gingival Crevicular Blood (GCB)
• Finger Capillary Blood (FCB)
• Venous Plasma Blood (VPB)

Patients were asked to use chlorhexidine mouthwash rinse before the screening. All of the GCB and FCB blood samples were analysed using a DrMorepen BG® glucose meter. At the same point of time, laboratory venous blood glucose estimation was done.

Gingival crevicular blood collection procedure: For estimation of blood glucose level using gingival crevicular blood, the test site was isolated with cotton roll and air dried with three-way syringe. Blood oozed out from gingival margin of the selected site was collected on to the test-strip. Site with profuse bleeding on probing was chosen. Sites which bleed easily during clinical examination were selected. Williams periodontal probe (Qulix) was used for gingival probing. When a sufficient quantity of blood was obtained, it was collected directly on the test strip of glucometer. After proper sample collection on the test strip, the glucometer unit was turned on and GCB glucose readings were recorded (Table/Fig 1). The glucometer gives blood glucose value in about five seconds. The value was noted as mg/dL Gingival Crevicular Blood Glucose (GCBG) value.

Finger capillary blood collection procedure: The surface of the fingertip was wiped with surgical spirit to estimate blood glucose levels using finger capillary blood. A sterile lancet was used to puncture the surface of the finger, and a drop of blood was allowed to be drawn to the test strip area. The FCB glucose measurements were recorded with glucometer (Table/Fig 2). The strip was inserted into the glucometer and the value obtained was recorded as Peripheral Finger stick Blood Glucose (PFBG) value.

Venous capillary blood collection procedure: The estimation of blood glucose level utilising venous blood was performed immediately after these two procedures. Using a sterile syringe and needle, blood was collected by puncturing the anterior cubital vein (Table/Fig 3). A 2 mL of blood was collected in a plane bulb and analysed. Glucose readings will be noted. The glucose estimation method employed was: GOD=POD method (combined action of glucose oxidase and peroxidase) (17). Glucoseoxidase (GOD) converts-D glucose to gluconic acid and generates hydrogen peroxide as a by product (H2O2). The Peroxidase (POD) enzyme produces nascent oxygen (O2) from hydrogen peroxide, which is then combined with 4-amino antipyrine and phenol to generate red quinoneimine colour. The amount of glucose in the plasma is directly proportional to the intensity of the colour (18).

Statistical Analysis

Mean and standard deviation for each clinical parameter was calculated. The GCB, FCB, and VCB glucose levels were recorded as mean and standard deviation. To compare the significance of the difference between the three readings, one-way Analysis of Variance (ANOVA) was performed and Karl Pearson’s correlation (r) was done to know the correlation between the three methods. Statistical Package for Social Sciences (SPSS) version 26.0 was used for statistical analysis and p-value ≤0.05 was considered as statistically significant.

Results

A total of 50 patients were included in the study with the age group 30 years and above fulfilling the inclusion criteria out of which 27 were known diabetics 23 were non diabetics. Out of 50 patients, 32 were females and 16 were males. Male to female ratio was 18:32. Diabetes showed a higher prevalence amongst females. The mean age was 51.57±13.27 years. The mean PPD was 5.5±0.61 mm and mean values of the CAL was 6.76±0.82 mm. The mean sulcus bleeding index score was 2.55±0.90. The mean PI score was 1.41±0.25 and mean gingival index score was 1.45±0.21 (Table/Fig 4).

The mean FCB glucose was 179±80.31 mg/dL, mean VCB glucose was 186±87.57 mg/dL and GCB glucose was 171±85.63 mg/dL. No significant difference between three types of readings (p-value=0.66) (Table/Fig 5). Partial eta square was 0.006 which means that 0.6% variance was found between the different techniques which can be attributed to different reading methods, therefore, any of the methods can be used for measurement of blood glucose level. Karl Pearson’s correlation was used to correlate GCB and FCB, GCB and VCB and also GCB and FCB values. Strong positive and highly significant correlation was observed between FCB glucose and VCB glucose values (r-value=0.976, p-value <0.001) (Table/Fig 6). The VCB and GCB when correlated showed strong positive and highly statistically significant results (r-value=0.934, p-value <0.001) (Table/Fig 7). Similarly, GCB and FCB showed a positive correlation (r-value=0.920, p-value <0.001) which was statistically highly significant (Table/Fig 8).

Discussion

Diabetes increases inflammation in the periodontal tissues (19).Over the last century, advances in science and technology have substantially increased our understanding of the pathophysiology of periodontal disease. Even though periodontal disease is an infectious illness, it can be influenced by certain systemic disorders. Diabetes mellitus is clinically and genetically a diverse illnesses involving carbohydrate and protein metabolism. There has been a lot of research done on the relationship between diabetes and inflammatory periodontal disease (20). The interaction between these two conditions appears to be cyclical as well as bidirectional. This has been confirmed in extensive reviews by Oliver RC and Tervonen T, and by Rees TD et al., (4),(21). Appropriately periodontal disease has been recognised as the sixth complication of diabetes (22). In fact, diabetes and periodontitis seem to interact in a bidirectional manner (23).

Periodontal inflammation, with or without a DM complication factor, is known to produce spontaneous bleeding from gingival sulcus on probing, during a diagnostic periodontal examination, it can be utilised to estimate random blood glucose levels (24).

The gold standard method of measuring blood glucose level in diabetic patients is venous plasma glucose that has the highest level of diagnostic accuracy (25), and it must be compared to the further two different non invasive methods in order to evaluate the corrleation of different methods for screening for blood glucose levels. Partheeban I et al., found in their study a strong positive correlations between these three methods in both diabetic and non diabetic patients, where they have used venous blood glucose level as a gold standard, the sensitivity and specificity of fasting plasma glucose was 93% and 100%, respectively in both their groups (26). The mean and SD of FCB was 179±80.31 mg/dL, VCB was 186±87.57 mg/dL and GCB was 171±85.63 mg/dL. The ANOVA showed no significant difference between all three types of readings (p-value=0.66). That shows no difference in any of the method for blood glucose measurement.

Earlier studies done by Stein GM and Nebbia AA (27), Beikler T et al., (28), Khader Y et al., (29) and most recent by Rapone B et al., (30) sought to demonstrate that extravasated blood from the gingival crevice as a result of bleeding on provocation during periodontal examination, can be used to measure blood glucose in diabetes patients these findings were similar to the present study. According to the current study findings, Pearson’s correlation coefficients between VCB and FCB, FCB and GCB and GCB and VCB were 0.976, 0.920 and 0.934, respectively, which were statistically highly significant respectively suggesting a strong positive correlation (r). The result of the present study is similar with most of the previous studies of Shetty S et al., (31) and Strauss SM et al., (32) which suggest that GCB sample analyses are satisfactory for screening diabetic patients with adequate bleeding on provocation, and that samples can be obtained quickly.

Results of study conducted by Jain S et al., (33) were similar to the prsent study where Pearson’s correlation showed a strong positive correlation between the two measurements (r-value=0.893, p-value <0.001). A recent study done by Vummidi AV et al., also demonstrated, strong positive correlation between gingivitis and significantperiodontitis patients (34). The present study data reveals that estimating sulcular blood glucose levels has an association with capillary and venous blood glucose levels, implying that measuring sulcular blood could be a useful tool in diagnosing diabetes patients. The ability to do the test at the chair side and the lack of a long wait time for results are two of the advantages of GCB glucose testing. In addition, a dentist can carry out the treatment (30).

According to the American Diabetic Association, blood glucose monitoring devices have a prediction error of less than 15% of the laboratory norm (35). Also, dental practitioners prefer intraoral sampling for DM screening since the sample may be taken during normal scaling and the strip system provides a more objective indicator for physician referral than the usual medical history review and observation of symptoms (36). In the present study, GCB was used for blood glucose estimation in all 50 subjects. Out of 50 subjects, 27 were known diabetics 11 were non diabetics and 12 were diagnosed of being diabetic at the time of chair side screening. Patients who had just been diagnosed with diabetes, were then referred to a physician, who validated the results using fasting blood sugar and postprandial blood sugar estimation. Out of 50, there were 32 females and 16 males. Prevalence of diabetes was higher in the females.

Limitation(s)

Larger sample sizes with more precise outcome measurement should be used in future investigations.

Conclusion

Gingival crevicular blood obtained during routine periodontal examination can be used for in-office diabetic screening. When correlated with the FCB and VCB blood glucose measurements (r-values=0.976 and 0.934) which shows strong positive correlations. The GCB glucose estimation is a safe, easy to perform, non invasive, less time-consuming chair-side method for diabetic screening. It can be used for diagnosing undiagnosed asymptomatic patients with diabetes in dental office and can prove to be a reliable method for referral to physician.

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DOI and Others

DOI: 10.7860/JCDR/2023/59578.17223

Date of Submission: Aug 10, 2022
Date of Peer Review: Sep 19, 2022
Date of Acceptance: Oct 26, 2022
Date of Publishing: Jan 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

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