|Year : 2015 | Volume
| Issue : 4 | Page : 253-256
Evaluation of salivary albumin in diabetic children
Syed Shahbaz1, Girish Katti1, Sreenivas Rao Ghali1, Chandrika Katti2
1 Department of Oral Medicine & Radiology, Al-Badar Rural Dental College & Hospital, Gulbarga, Karnataka, India
2 Department of Orthodontics, Al-Badar Rural Dental College & Hospital, Gulbarga, Karnataka, India
|Date of Web Publication||14-Dec-2015|
Department of Oral Medicine & Radiology, Al-Badar Rural Dental College & Hospital (ARDCH), Gulbarga, Karnataka
Source of Support: The study has not been funded by any source or agency, Conflict of Interest: None
Aim: To evaluate salivary albumin in insulin-dependent diabetes mellitus (IDDM) patients and to compare with the healthy nondiabetic control group.
Study Design: The study consisted of 30 IDDM patients and 30 age- and sex-matched healthy controls. All the subjects were subjected to salivary albumin estimations. The salivary albumin estimations were done by bromocresol green (BCG) dye method, end point. All the estimations were performed using an AutoAnalyzer.
Results: The results showed elevated levels of salivary albumin in the IDDM group compared to the healthy controls.
Conclusion: The salivary albumin can be used to assess the metabolic status of the diabetic subjects since it showed increased levels compared to the healthy controls. Salivary parameters can act as adjuncts in assessing the overall metabolic status of the patient.
Keywords: Albumin, diabetes mellitus (DM), insulin-dependent diabetes mellitus (IDDM), saliva
|How to cite this article:|
Shahbaz S, Katti G, Ghali SR, Katti C. Evaluation of salivary albumin in diabetic children. J NTR Univ Health Sci 2015;4:253-6
| Introduction|| |
Diabetes mellitus (DM) is an endocrine disease characterized by a shortfall in the production of insulin with consequent alteration of the process of assimilation, metabolism, and balance of blood glucose concentration.  Incidentally, an array of oral manifestations has been reported in the diabetic population. Oral physicians tend to play a pivotal role in detecting and diagnosing this endocrine disease on the basis of oral signs and symptoms. 
Although all forms of DM are characterized by hyperglycemia, the pathogenic mechanisms by which hyperglycemia arises differ widely. Thus, diabetes is classified as type I [insulin-dependent diabetes mellitus (IDDM)] and type II [noninsulin-dependent diabetes mellitus (NIDDM)]. Type I results from destruction of the beta cells of the pancreas, causing an absolute deficiency of insulin while type II results from cellular dysfunction in resistance to insulin by the peripheral tissues. The incidence rate of type I in India is 4.2/100,000 people per year. ,,
Saliva is an organic fluid that can indicate local and systemic alterations, such that the components of saliva can be related to the hormonal, immunological, neurological, nutritional, and metabolic state of an individual. , Albumin is regarded as serum ultrafiltrate to the mouth and it may diffuse into the mucosal secretions. ,
It has become apparent that saliva has many diagnostic uses, especially in large-scale screening and epidemiological studies.  In the light of the above context, this study was undertaken to evaluate salivary albumin in IDDM patients and to compare the same with healthy nondiabetic controls.
| Materials and methods|| |
The study was conducted on 30 patients with IDDM and 30 age- and sex-matched healthy nondiabetic individuals. The IDDM group and the control group consisted of 16 males and 14 females, respectively. The patients included in the study were taken from district general hospitals, diabetic care centers, and the outpatient department (OPD) of our dental college and hospital. Patients of IDDM and those individuals who volunteered to participate in the study were included, and informed consent was obtained from both the groups; ethical clearance was obtained from institutional Ethics Committee.
Patients having systemic diseases other than DM and those with type II DM were excluded from the study.
Method of study
All the subjects included in the IDDM group and the control group were subjected to the following procedure. Consent of the patient's parent was obtained prior to performing the procedure. All the patients were advised not to eat anything until the samples were collected. The saliva samples from both the study group and the control group were collected between 8 AM and 10 AM.
Method of saliva collection
The unstimulated whole saliva was collected by the spitting method. The patients involved in the study were asked to rinse the mouth thoroughly with water, twice. Unstimulated whole saliva samples were collected at one sitting, during a period of 5 min. For collection of saliva, the subjects were asked to generate saliva in their mouths and to spit into a sterile plastic container.
The containers were kept on ice pack until the analysis was performed. The collected saliva was subjected to albumin estimation.
Methods of estimation
The salivary albumin estimations were performed by bromocresol green (BCG) dye method, albumin binds with BCG at pH 4.2 causing a shift in the absorbance of the yellow BCG dye; the blue-green color formed is proportional to the concentration of albumin present when measured photometrically between 580 nm and 630 nm, with the maximum absorbance at 625 nm. ,
All the estimations were performed using reagent kits of Transasia Bio-Medicals Ltd. and an AutoAnalyzer (ERBA, Mannheim, Germany).
The recorded data were analyzed using Statistical Package for the Social Sciences version 11.5 software (SPSS Inc., Chicago, IL, USA). Descriptive statistics included computation of the mean and the standard deviation (SD). Student's t-test was used for the analysis. For all the tests, P value was set at ≤0.05.
| Results|| |
Our study consisted of 30 diagnosed IDDM patients and 30 age-matched healthy controls. The IDDM group and the control group consisted of 16 males and 14 females, respectively, with the age ranging 4-16 years. The saliva samples were collected with their consent. The samples were analyzed for salivary albumin by using an AutoAnalyzer. The salivary albumin measurements were recorded and the results were statistically analyzed for mean and SD.
The mean salivary albumin level in the control group was 59.0 mg/dL and SD 14.69, and the levels ranged 36-81 mg/dL. The mean salivary albumin level in the IDDM group was 87.86 mg/dL and SD 6.54, and the levels ranged 78-96 mg/dL [Table 1] and [Graph 1].
The "t" value for the comparison of salivary albumin in the IDDM group and the control group was 9.85 and P < 0.001, which is statistically very highly significant (VHS). In our study, the results can be interpreted as the levels of salivary albumin remarkably increasing in the IDDM group than in the control group.
| Discussion|| |
Saliva, indeed, is a mirror of our blood as these biofluids and their molecular components share many similarities. Realization of this fact and the possible utility of saliva as a diagnostic biofluid, using recent technological advances, have enabled many researchers to develop saliva-based technology to detect the transition between health and disease. As a diagnostic fluid, saliva offers distinctive advantages over serum because it can be collected noninvasively by individuals with modest training. Furthermore, saliva may provide a cost-effective approach for the screening of a large population. 
It has been beautifully said by Mandel that "saliva lacks the drama of blood, sincerity of sweat and emotional appearance of tears," but the fact is remains that it is the vital element that sustains life in the oral cavity. The constituents of saliva not only maintain the oral health but also play a vital role in the diagnosis of various oral diseases like oral cancer, candidiasis, periodontal disease, etc. as well as detection of numerous systemic diseases like human immunodeficiency virus (HIV) infection, diabetes, heart diseases, etc. 
Among the various systemic diseases, the most routinely encountered disease is DM. It is a group of metabolic disorders that shares the common underlying feature of hyperglycemia. Hyperglycemia in diabetes results from defects in insulin secretion, insulin action, or both. Diabetes is broadly classified into IDDM and NIDDM. IDDM is a severe disease that raises blood glucose concentration because of hyperglycemia and insulinopenia. 
Albumin is the most osmotically active and abundant serum protein, accounting for more than 50% of all plasma proteins. It is exclusively synthesized in the liver at a rate of 100-200 mg/kg/day. The factors that regulate albumin synthesis are nutrition, hormonal balance, and osmotic pressure. The half-life of albumin is approximately 15-20 days. About 4% of albumin is degraded per day, but synthesis can be increased by as much as 100% by conditions that decrease serum albumin or lower intravascular osmotic pressure. 
In the oral cavity, albumin is regarded as a serum ultrafiltrate to the mouth and it may diffuse into the mucosal secretions. Salivary albumin is increased in immunosuppression, diabetes, and radiotherapy. It may be hypothesized that salivary albumin can be used to assess the integrity of mucosal function in the mouth. Albumin is often used as a marker for the degree of mucositis or inflammation in the oral cavity. 
The salivary albumin levels in our study were higher in the IDDM group compared to the control group [Table 1] and [Graph 1][Additional file 1]; these results are in concordance with the previous studies done by Gheena et al.  and Amita et al.  However, studies done by Vaziri et al.,  Fisher et al.,  and Belazi et al.  showed no change in the salivary albumin levels in the IDDM group compared to the control group. The elevated levels could be explained with abnormal binding of serum proteins to the salivary gland and basement membranes may be a reflection of increased permeability; this basement membrane permeability is often associated with diabetes that leads to the increased passage of proteins, immunoglobulin G (IgG), albumin, and polyvalent immunoglobulins from the exocrine glands into their secretions. 
The salivary flow rate in diabetes is also diminished, which is related to salivary viscosity and foam. Viscosity, otherwise called "spinnbarkeit," and foam are reflected by the higher levels of proteins. Salivary turbidity is related to mucus, epithelial cells, and especially to the presence of oral bacteria.  In conjugation to serum, the salivary albumin is regarded as a serum ultrafiltrate to the mouth and hence can be a reliable source to assess mucosal function in the oral cavity, as few studies have shown positive correlation between gingival index and the concentrations of total protein, albumin, lysozyme, and lactoferrin in both IDDM and NIDDM patients. ,
| Conclusion|| |
Total saliva is a fluid of easy collection that could help diagnosing or monitoring systemic illness, such as diabetes. It has been validated that saliva composition may correspond to the systemic state of the patient rather than merely the oral health state. The salivary albumin can be used to assess the metabolic status of diabetic subjects since it showed increased levels compared to the healthy controls. Salivary parameters can act as adjuncts in assessing the overall metabolic status of the patient. Further studies should be performed to make these tests equivalent to a blood test.
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