Home About us Editorial board Ahead of print Current issue Archives Submit article Instructions Subscribe Search Contacts Login 
  • Users Online: 557
  • Home
  • Print this page
  • Email this page


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 27  |  Issue : 3  |  Page : 338-342

Correlation of blood glucose level in gingival crevicular blood and finger capillary blood using glucometer


1 Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
2 Department of Oral Medicine and Radiology, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
3 Department of Oral Medicine and Radiology, SMBT Dental College and Hospital and Post Graduate Research Centre, Sangamner, Maharashtra, India

Date of Submission28-Apr-2015
Date of Acceptance11-Nov-2015
Date of Web Publication25-Nov-2015

Correspondence Address:
Supreet Jain
Jain Handloom, Jain Furniture, Telipara, Near Bus Stand, Bilaspur - 495 001, Chhattisgarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.170439

Rights and Permissions
   Abstract 

Aim: The aim of the study was to assess the reliability of gingival crevicular blood (GCB) glucose level compared with finger capillary blood (FCB) glucose level using a glucose self-monitoring device (Contour ® TS). Materials and Methods: One hundred randomly selected patients with gingivitis (45 subjects) and periodontitis (55 subjects) were included in the study. The mean age of the study group subjects was 35.39 ± 11.97 years (range 17-70 years). The blood glucose values obtained from GCB elicited during routine periodontal probing and those of peripheral finger stick blood glucose were recorded using a glucose self-monitoring device (glucometer) during fasting and postprandial phases. Statistical analysis was done using Student's "t" test and Karl Pearson's product moment correlation. The regression analysis was then performed to compare the GCB and FCB blood glucose readings using the approach of Bland and Altman. Results: There was no statistically significant difference (t = 1.443, P = 0.152) between the fasting GCB and FCB glucose values, but it was significant during postprandial measurement (t = 6.893, P < 0.001). Pearson's correlation showed a positive correlation between the two measurements (r = 0.893, P < 0.001). Bland-Altman regression analysis revealed sufficient agreement between the two values. Conclusion: The results suggest that GCB collected during diagnostic periodontal examination may be an excellent source of blood for glucometric analysis. Thus, it can be used as a chairside investigative procedure.

Keywords: Blood glucose level, finger capillary blood, gingival crevicular blood


How to cite this article:
Jain S, Shashikanth MC, Sur J, Khan F, Mujoo S, Dewangan D. Correlation of blood glucose level in gingival crevicular blood and finger capillary blood using glucometer. J Indian Acad Oral Med Radiol 2015;27:338-42

How to cite this URL:
Jain S, Shashikanth MC, Sur J, Khan F, Mujoo S, Dewangan D. Correlation of blood glucose level in gingival crevicular blood and finger capillary blood using glucometer. J Indian Acad Oral Med Radiol [serial online] 2015 [cited 2023 Jan 29];27:338-42. Available from: http://www.jiaomr.in/text.asp?2015/27/3/338/170439


   Introduction Top


Diabetes mellitus (DM) is a complex metabolic disorder characterized by hyperglycemia resulting from a defect in insulin secretion, insulin action, or both. [1] Diabetics suffer from microvascular changes in small vessels of the oral tissues. [2] Gingival inflammation with or without the complicating factor of DM is known to produce ample extravasated blood during routine probing, and is less traumatic than a finger puncture with a sharp lancet. [3] The aim of the study was to assess the reliability of gingival crevicular blood (GCB) glucose compared with finger capillary blood (FCB) glucose level using a glucose self-monitoring device.


   Materials and Methods Top


The present study involved 100 randomly selected patients with gingivitis and periodontitis from the out-patient Department of Oral Medicine and Radiology. The exclusion criteria included the following: Patients with bleeding disorder, patients with history of prolonged usage of analgesics (aspirin) or anticoagulants, and patients with severe systemic diseases such as cardiovascular, renal, hepatic, immunologic, or hematological disorders. The subjects who fulfilled the selection criteria were asked to come in the morning after fasting overnight. Only those patients who gave a signed informed consent were included in the study. Patient's general and detailed medical, family, and personal history was recorded and the clinical examination was performed. All the data collected were entered in the specially designed proforma. Periodontal conditions were assessed for every tooth present. Periodontal probing depth and clinical attachment level were measured with a calibrated probe (William's graduated probe).

An appropriate site was chosen for collecting the gingival crevice blood (GCB) sample. Mostly, maxillary anterior teeth and premolars were chosen for glucose measurements as they offer easy access for GCB. For each measurement, only one site with bleeding on probing was selected. Sites with suppuration were excluded from the study. After selecting the bleeding site, the site was isolated with gauze or cotton rolls. The interdental papilla either between the incisors or between the incisors and canines or between the canine and premolars or between the premolars was probed with William's graduated probe. As soon as the probe was removed, the gingival crevice was observed for bleeding. At this stage, the test end of the strip [mounted on the Blood Glucose Monitoring System (Contour ® TS; Bayer Health Care LLC, Mishawaka, Indiana, USA)] was made to touch the bleeding site to obtain the blood sample on the test strip without contacting the gingival or palatal tissues. The test strip was held until the instrument beeped showing the meter count down 8 s. Later, the blood glucose measurement displayed in mg/dl was recorded [Figure 1].
Figure 1: Figure showing GCB reading

Click here to view


Immediately after measuring glucose levels in GCB, an FCB sample was drawn from the right index finger. The soft tissue surface of the finger was wiped with surgical spirit and the spirit was allowed to evaporate. The finger was punctured with a sterile disposable lancet and a drop of blood was allowed to form on the finger. The first drop of blood was discarded and as soon as the second drop of blood was formed, the test end of the strip was made to touch the bleeding site and was held until the instrument beeped showing the meter count down 8 s. Later, the blood glucose measurement displayed in mg/dl was recorded [Figure 2]. Then the patients were instructed to take 75 g of glucose and after 2 h, 6 μl of blood was again collected to perform postprandial (PP) blood sugar test from the gingiva and finger.
Figure 2: Figure showing FCB reading

Click here to view


Statistical analysis

Statistical analysis was done using Statistical Package of Social Science (SPSS Version 16; SPSS Inc., Chicago, IL, USA). Data comparison was done by applying specific statistical tests to find out the statistical significance of the comparisons. Quantitative variables were compared using mean values and standard deviations. Descriptive data are presented as mean ± standard deviation (SD) and range values. To compare significant differences between GCB glucose values and FCB glucose values during fasting and PP phases, Student's unpaired "t0" test was conducted and the "P"-values were calculated. [4] A P-value of 0.05 or less was considered for statistical significance.

Karl Pearson's product moment correlation coefficients for GCB and CFB glucose readings were computed during fasting and postprandially. [5] A value of correlation coefficient close to +1 was considered as a strong positive linear relationship (i.e. one variable increases as the other) and a value close to −1 was considered as a strong negative linear relationship (i.e. one variable decreases as the other increases), and a value close to 0 was considered as no linear relationship. A regression analysis was then performed comparing the two blood glucose readings using the approach of Bland and Altman. [6] In particular, limits of agreement between the two readings were computed to provide a range of values within which 95% of the differences between the two readings were expected to fall. In addition, a graphic display was created for fasting and PP glucose levels in GCB and FCB, as suggested by Bland and Altman, to assess the likelihood of bias and possible outliers. Although an unpaired "t0" test analysis would have enabled an examination of differences between the GCB and CFB glucose measures, the Bland and Altman approach was chosen for the current analyses because the focus was on examining agreement between the two measures.


   Results Top


The study involved a total of 100 subjects of which 61 were males and 39 were females. The mean age of the study group subjects was 35.39 ± 11.97 years (range 18-70 years). The mean values of fasting GCB and fasting FCB glucose levels derived from all samples were 91.60 ± 26.90 mg/dl (range 61-299 mg/dl) and 89.85 ± 23.85 mg/dl (range 61-275 mg/dl), respectively, while the PP GCB and FCB glucose levels were 132.70 ± 42.94 mg/dl (range 81-389 mg/dl) and 119.30 ± 40.24 mg/dl (range 69-398 mg/dl), respectively.

Statistical analysis using Student's "t" test (unpaired t-test) showed no significant difference between the fasting glucose levels collected from gingival crevice and capillary blood (t value = 1.443, P = 0.152, not significant). But it was highly significant during PP period with a mean difference of 13.4 ± 19.44 mg/dl (t value = 6.893, P < 0.001). The Pearson's correlation coefficient between fasting and PP GCB and FCB samples was 0.893 (P < 0.001) [Table]. The correspondence between the GCB and FCB readings, together with the line of equality, suggests no systematic bias in GCB and FCB comparisons [Graph 1 and Graph 2].





An analysis of agreement (Bland and Altman regression analysis) was also carried out between the two measurements on fasting and PP values. The difference between the fasting GCB and FCB values ranged from −23 to 33 mg/dl (mean 1.75 ± 12.13) and during the PP phase, it was from −17 to 112 mg/dl (mean 13.40 ± 19.44 mg/dl). The 95% coefficient of agreement was 23.77 during fasting (1.96 times the SD of difference in the readings) and 38.08 during the PP phase. If the differences follow a normal distribution, 95% of the differences are expected to lie in between the mean of differences between fasting GCB and FCB values ± 1.96 times the SD of these differences, i.e. −22.02 to 25.52 with 95% CIs for the lower and upper limits of agreement of −31.3 to −18.1 and 44.9-58.1, respectively. During the PP phase, 95% of the difference is expected to lie between −24.68 and 51.48, with 95% CIs for the lower and upper limits of agreement of −26.2 to −17.9 and 21.4-29.7, respectively [Table 1] and Graph 3].
Table 1: Analysis of repeatability/agreement of measurements/ Bland and Altman regression analysis of blood glucose levels in GCB and FCB samples

Click here to view





   Discussion Top


DM is a complex metabolic disorder characterized by hyperglycemia resulting from defect in insulin secretion, insulin action, or both. [1],[7] In 1997, the International Expert Committee classified diabetes into Type 1, Type 2, other specific type, and gestational DM. [8] The prevalence of DM is growing rapidly worldwide and is reaching epidemic proportions. It is estimated that there are currently 285 million people with diabetes worldwide and this number is set to increase to 438 million by the year 2030. [9],[10] In addition, recent data indicate that the incidence of type 2 DM may be increasing by up to 6% per year. [11]

Major complications of diabetes are cardiovascular diseases (such as angina, hypertension, infarction), cerebrovascular diseases (such as stroke), neuropathy, nephropathy, ocular disease, and diabetic foot. [12] Undiagnosed diabetic patients are at significantly increased risk for the development of complications. It has been estimated that about one-third of type 2 DM cases are undiagnosed. [11] Periodontal disease is considered as the sixth complication of diabetes. Since periodontal inflammation with or without the complication factor of DM is known to produce ample amount of blood during diagnostic periodontal examination, no extra procedure (like finger puncture with a sharp lancet) is necessary to obtain blood for glucometric analysis. Even in the case of very low gingival crevicular bleeding, a glucose measurement is possible with the use of self-monitoring device due to the low amount of blood necessary to perform the analysis. [12] Glucose testing with the Contour ® TS self-monitoring device is sensitive, since it can provide results with just 6 μl of blood within 8 s. [13],[14]

Muller et al. reported that Pearson's correlation analysis is inappropriate when assessing agreement between the two methods of measurements. Therefore, to examine agreement between the two values of glucose in GCB and FCB during fasting and PP phases and to eliminate any discrepancy, the Bland and Altman regression analysis approach was also used in the present study. The present study showed no statistical difference between the fasting gingival crevicular and finger capillary blood glucose levels (t = 1.443, P > 0.05) and the Pearson's correlation coefficient was highly significant and showed positive correlation between the two values (r = 0.893, P < 0.001). The result was consistent with the result obtained by Sarlati et al. [15] Khader et al. showed a significant difference between fasting GCB and FCB glucose values when measured with self-monitoring device, which was not consistent with the present study. [16]

In the present study, Bland-Altman regression analysis showed fasting 95% limit of agreement to be between −22.02 and 25.52, which was not consistent with the finding of Sarlati et al. [15] This interval is narrow, indicating that small differences in measurements were seen during fasting. The fasting 95% coefficient of agreement interval for the study participants was 23.77. There was a statistically significant difference between PP GCB and FCB glucose values (t = 6.893, P < 0.001), which was similar to the result of Meti et al., [17] while Pearson's correlation coefficient between the GCB and FCB glucose levels was highly significant and showed a positive correlation (r = 0.893, P < 0.001). The result was inconsistent with those of other authors. [7],[11],[12],[17],[18] Positive correlation between GCB and FCB may be due to the elimination of sample contamination with gingival crevicular fluid.

In the present study, Bland and Altman regression analysis showed PP 95% coefficient of agreement interval for the study participants as 38.08 and 95% limit of agreement was between −24.68 and 51.48 during the PP phase. This interval is slightly broad, indicating that large differences in measurements were seen during PP phase. The result was not consistent with that of Müller and Behbehani. [19],[20] Strauss et al. reported a broad width of 95% limit of agreement and concluded that GCB in such patients cannot be used for glucose estimation. [21] The results of the present study suggest that both fasting and PP GCB are useful for testing blood glucose during routine periodontal examination, but fasting GCB may give better results. Thus, GCB glucose estimation may prove to be a promising approach in routine dental office screening for DM in periodontal patients. The patients who feel uncomfortable with finger prick puncture method may be eased by the GCB technique.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183-97.  Back to cited text no. 1
    
2.
Ervasti T, Knuuttila M, Pohjamo L, Haukipuro K. Relation between control of diabetes and gingival bleeding. J Periodontal 1985;56:154-7.  Back to cited text no. 2
    
3.
Parker RC, Rapley JW, Isley W, Spencer P, Killoy WJ. Gingival crevicular blood for assessment of blood glucose in diabetic patients. J Periodontol 1993;64:666-72.  Back to cited text no. 3
    
4.
Whitley E, Ball J. Statistics review 5: Comparison of means. Crit Care 2002;6:424-8.  Back to cited text no. 4
    
5.
Bewick V, Cheek L, Ball J. Statistics review 7: Correlation and regression. Crit Care 2003;7:451-9.  Back to cited text no. 5
    
6.
Altman DG, Bland JM. Measurement in medicine: The analysis of method comparison studies. Statistician 1983;32:307-17.  Back to cited text no. 6
    
7.
Gaikwad S, Jadhav V, Gurav A, Shete AR, Dearda HM. Screening for diabetes mellitus using gingival crevicular blood with the help of self-monitoring device. J Periodontal Implant Sci 2013;43:37-40.  Back to cited text no. 7
    
8.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;33(Suppl 1):S62-9.  Back to cited text no. 8
[PUBMED]    
9.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.  Back to cited text no. 9
    
10.
Anjana RM, Ali MK, Pradeepa R, Deepa M, Datta M, Unnikrishnan R, et al. The need for obtaining accurate nationwide estimates of diabetes prevalence in India - rationale for a national study on diabetes. Indian J Med Res 2011;133:369-80.  Back to cited text no. 10
[PUBMED]  Medknow Journal  
11.
Hussain AJ, Sunil M, Chai Liu DT. Assessment of blood glucose using gingival capillary blood - A chairside method. SRM University J Dent Sci 2010;1:36-40.  Back to cited text no. 11
    
12.
Beikler T, Kuczek A, Petersika G, Flemmig TF. In-Dental office screening for diabetes mellitus using gingival crevicular blood. J Clin Periodontal 2002;29:216-8.   Back to cited text no. 12
    
13.
Contour TS User Guide. 2007. Available from: http://www.bayerdiabetes.hk/web/Image/99918079_CntrTS_CSEA_UG_R807.pdf. [Last accessed on 2015 Jan 28].  Back to cited text no. 13
    
14.
Frank J, Wallace JF, Pardo S, Parkes JL. Performance of the Contour ® TS blood glucose monitoring system. J Diabetes Sci Technol 2011;5:198-205.  Back to cited text no. 14
    
15.
Sarlati F, Pakmehr E, Khoshru K, Akhondi N. Gingival crevicular blood for assessment of blood glucose levels. J Periodontol Implant Dent 2010;2:17-24.  Back to cited text no. 15
    
16.
Khader YS, Al-Zu'bi BN, Judeh A, Rayyan M. Screening for type 2 diabetes mellitus using gingival crevicular blood. Int J Dent Hyg 2006;4:179-82.  Back to cited text no. 16
    
17.
Meti M, Praveenkumar SR, Kalburgi V. Screening for diabetes mellitus using gingival crevicular blood. J Oral Health Res 2010;1:160-4.  Back to cited text no. 17
    
18.
Kumar P, Panseriya BJ, Balani A. Gingival crevicular blood: A fast, safe, noninvasive and chairside method of diabetic screening. Int J Sci Study 2013;1:26-31.  Back to cited text no. 18
    
19.
Müller HP, Behbehani E. Screening of elevated glucose levels in gingival crevice blood using a novel, sensitive self-monitoring device. Med Princ Pract 2004;13:361-5.  Back to cited text no. 19
    
20.
Müller HP, Behbehani E. Methods for measuring agreement: Glucose levels in gingival crevice blood. Clin Oral Investig 2005;9:65-9.  Back to cited text no. 20
    
21.
Strauss SM, Wheeler AJ, Russell SL, Brodsky A, Davidson RM, Gluzman R, Li L, et al. The potential use of gingival crevicular blood for measuring glucose to screen for diabetes: An examination based on characteristics of the blood collection site. J Periodontol 2009;80:907-14.  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

   Abstract Introduction Materials and Me... Results Discussion Article Figures Article Tables
  In this article
 References

 Article Access Statistics
    Viewed3058    
    Printed82    
    Emailed0    
    PDF Downloaded648    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]