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      Evaluation of Glycemic Control in Type 2 Diabetes Mellitus using Cytomorphometry of Buccal Cells and Correlation with Glycosylated Hemoglobin

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          To study cytological alterations in the exfoliated buccal cells of diabetic patients. To analyze the cytomorphometric findings in the smears of uncontrolled and controlled diabetic patients and compare it with that of normal healthy controls. To establish a correlation between cytomorphometric changes and glycosylated hemoglobin (HbA 1c) in diabetics and normal controls, for evaluation of glycemic control.

          Materials and Methods:

          The study was carried out in 40 confirmed diabetic patients from a hospital out-patient diabetic ward and 20 healthy individuals as controls (Group A: n = 20), in Chennai. Specific exclusion criteria were used to select the study group from a larger group of subjects. Based on HbA 1c values, the diabetic patients were categorized into Group B = Controlled diabetics (n = 20) (HbA 1c <7%) and Group C = Uncontrolled diabetics (n = 20) (HbA 1c >9%). After informed consent, buccal smear was collected from clinically normal appearing mucosa and stained with papanicoloau (PAP) stain. Cytomorphometric analysis of selective PAP stained cells was done using image analysis software, Image Pro Plus 5.5 (Olympus) and parameters determined were average cytoplasmic area (CA), average nuclear area (NA) and cytoplasmic:nuclear (C: N) ratio for an average of 50 cells/patient.


          Comparing the average NA among three groups, an increase through Group A, B, C, with a maximum significance between Group C and A was seen. The average C: N ratio showed a statistically significant difference between all three groups. Significant correlation existed between the HbA 1c values and both the C: N ratio and average NA in all the three groups.


          Cytomorphometric analysis of buccal smears using the C: N ratio alteration as a reliable criteria, may serve as yet another non-invasive tool for screening programs for diabetic detection. And the technique may possibly be used also for evaluation of glycemic control in known diabetics.

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          Most cited references 8

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          The current state of diabetes mellitus in India.

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            Cytomorphometric analysis of squames obtained from normal oral mucosa and lesions of oral leukoplakia and squamous cell carcinoma.

            Cell and nuclear diameters (CD and ND) were measured in squames obtained from normal buccal mucosa and lesions of oral leukoplakia and squamous carcinoma (SCC) also from buccal mucosa. The study groups consisted of Group 1: normal buccal mucosa (n = 40); Group 2: lesions with no epithelial dysplasia (n = 58); Group 3: lesions with epithelial dysplasia (n = 27); and Group 4: SCC lesions (n = 51). The mean CD and ND values were: Group 1: 51.78 (+/- 0.11) and 8.36 (+/- 0.49); Group 2: 45.73 (+/- 0.16) and 8.31 (+/- 0.68); Group 3: 41.32 (+/- 0.13) and 9.04 (+/- 0.46); Group 4: 38.58 (+/- 0.11) and 10.10 (+/- 0.56) microns, respectively. Correlation between the ND and CD was positive for Group 1 (r = 0.78, P < 0.05) and Group 2 (r = 0.33, P < 0.05). There were no significant correlations in Groups 3 and 4. ANOVA showed significant differences (P < 0.05) for CD between all four groups. Except between Groups 1 and 2, the ND was significantly different (P < 0.05) between all groups. The results indicate that ND and CD could possibly be sensitive parameters in the diagnosis of oral premalignant and malignant lesions.
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              Exfoliative cytology of the oral mucosa in type II diabetic patients: morphology and cytomorphometry.

              In recent years, important advances have occurred in the determination of diagnostic criteria for the disease diabetes mellitus and in new strategies for its treatment. The purpose of this research was to develop a new method for diabetes diagnosis by microscopic and cytomorphometric analyses of the oral epithelium. The smears were obtained from three distinct oral sites: buccal mucosa (cheek), tongue dorsum, and floor of the mouth in 10 control individuals and 10 type II diabetic patients. The oral smears were stained with Papanicolaou EA-36 solution. The nuclear (NA) and cytoplasmic (CA) areas were evaluated from 50 integral cells predominant in each oral site by the use of the KS 300 image analysis system (Carl Zeiss, Germany), by which the cytoplasmic/nuclear ratio (C/N) was calculated. The results showed that: (i) the epithelial cells of the diabetic group exhibited figures of binucleation and occasional karyorrhexis in all layers; (ii) the NA was markedly higher (P 0.05) between these two groups; and (iv) the C/N mean was 37.4% lower in the type II diabetic group. These results associated with clinical observations suggest that diabetes mellitus can produce alterations in oral epithelial cells, detectable by microscopy and cytomorphometry, which can be used in the diagnosis of this disease.

                Author and article information

                J Int Oral Health
                J Int Oral Health
                Journal of International Oral Health : JIOH
                Dentmedpub Research and Printing Co (India )
                February 2015
                : 7
                : 2
                : 20-24
                [1 ]Reader, Department of Oral Pathology, SRM Dental College, Chennai, Tamil Nadu, India
                [2 ]Professor and Head, Department of Oral Pathology, Sri Ramachandra Dental College, Chennai, Tamil Nadu, India
                [3 ]Oral Physician and Radiologist, Radiant Smile Care, Chennai, Tamil Nadu, India
                [4 ]Post-graduate Student, Department of Oral Pathology, SRM Dental College, Chennai, Tamil Nadu, India
                [5 ]Senior Lecturer, Department of Periodontics, Sri Venkateshwara Dental College, Chennai, Tamil Nadu, India
                [6 ]Professor, Department of Periodontics, Sri Venkateswara Dental College, Chennai, Tamil Nadu, India
                Author notes
                Correspondence: Dr. Karthik KR. SRM Dental College, Ramapuram, Bharathi Salai, Ramapuram, Chennai - 600 089, Tamil Nadu, India. Email: radiantsmilecare@ 123456gmail.com
                Copyright: © Journal of International Oral Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Original Research


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