|Year : 2015 | Volume
| Issue : 2 | Page : 60-64
Salivary IgA concentration in diabetic patients compared to healthy controls
Farimah Sardari1, Afshin Tahmasbi2, Arash Ghanbarzadegan3
1 Department of Oral Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
2 Department of Internal Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
3 Department of Dental Student, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
|Date of Web Publication||10-Jun-2015|
Asst Prof. Farimah Sardari
Department of Oral Medicine, Rafsanjan University of Medical Sciences, Rafsanjan
Source of Support: This study was financially supported by funds of Rafsanjan University of Medical Sciences, Rafsanjan, Iran (Grant number: 390049).,, Conflict of Interest: None
Introduction: The alterations in salivary flow rate and its compositions could affect the development, symptoms, and severity of oral changes in diabetic patients. The aim of this study was to assess the concentration of salivary IgA in type I in comparison with type II diabetic patients and healthy controls. Materials and Methods: In this cross-sectional study, 25 patients with type I diabetes, 25 patients with type II diabetes, and 25 control subjects (12 subjects for the type I and 13 subjects for the type II) were enrolled. Unstimulated saliva samples were collected by spitting method and the concentration of salivary IgA was measured byenzyme-linked immunosorbent assay (ELISA) method. Results: The mean of salivary IgA in type I diabetic patients was 148.3 ± 38.7 μg/ml and in their controls was 65.8 ± 17.4 μg/ml (P < 0.001). In type II diabetic patients the mean of salivary IgA was 67.3 ± 20.6 μg/ml and in their controls was 63.3 ± 15.2 μg/ml. There was no significant difference between patients with type II diabetes and controls (P = 0.54). The mean of salivary IgA in patients with type I diabetes was significantly higher than in patients with type II diabetes (148.3 ± 38.7 versus 67.3 ± 20.6 μg/ml, respectively, P < 0.001). Conclusions: Level of salivary IgA in type II diabetic patients in comparison with their healthy control did not show any significant difference, but in type I diabetic patients was higher than that of healthy controls and type II diabetic patients.
Keywords: Diabetic mellitus, IgA, saliva
|How to cite this article:|
Sardari F, Tahmasbi A, Ghanbarzadegan A. Salivary IgA concentration in diabetic patients compared to healthy controls. Dent Hypotheses 2015;6:60-4
| Introduction|| |
Diabetes has affected more than 366 million people in both developed and developing countries, and its incidence is increasing every year and has now reached epidemic proportions worldwide. , Diabetes mellitus (DM) is a systemic disease involving multiple organs and is characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. , Type I and type II diabetes are the two major types of diabetes. 
Type I diabetes is caused by absolute insulin deficiency resulting from autoimmune destruction of pancreatic beta-cells. An approximate population incidence of type Idiabetes is 25 of 100,000; with the highest incidence at the age of 13-15. For the etiopathology of type Idiabetes, the substitution of missing insulin represents the only therapeutic option. ,,,,,,,
Type II diabetes is characterized by a relative insulin deficiency resulting from a reduced sensitivity of tissues to insulin and impairment of insulin secretion from pancreatic beta-cells. Some patients are characterized by predominant insulin resistance and relative insulin insufficiency, while the others have a major defect in insulin secretion combined with insulin resistance. Type II diabetes represents more than 80% of the diabetes cases. The prevalence of type II diabetes is growing much more than what was previously estimated. ,,,,,,,,,,,,,,
Some of oral diseases are more prevalent in the poor-controlled diabetic patients such as periodontal diseases (PDs), dental caries, xerostomia, and recurrent periapical abscess. ,, The relationship between DM and PD has been widely reported. Diabetes is an example of a systemic disease with marked oral manifestations and defective host immune responses, which influence the development and severity of PD. 
Saliva is recognized as a way of investigation and diagnosis in many medical areas.  Saliva is currently used for the diagnosis of various conditions and diseases and for monitoring their treatment. It has been reported that the alterations in salivary flow rate and its compositions could affect the development, symptoms, and severity of oral changes in diabetic patients and it has also been noted that detection of salivary constituents in diabetic patients may be useful in the understanding and management of the oral manifestations. ,
Specific antibody systems are found in saliva.  Secretory immunoglobulin A (IgA) acts to neutralize viruses, serves as an antibody to bacterial antigens, and works to aggregate or clump bacteria, and also inhibiting bacterial attachment.  Some physical, chemical, and behavioral factors affect secretion of saliva such as pain; certain types of medication; and various local, systemic, and emotional diseases. , Salivary IgA can serve as a first line of defense against pathogens that colonize and invade mucosal surfaces and may be protective against PD.  The role of IgA levels in the susceptibility to oral diseases among diabetic patients is not, however, well understood, and existing studies have shown contradictory results. So, the present study was designed to compare the IgA level in diabetic patients (type I and II) and healthy controls.
| Materials and Methods|| |
In this cross-sectional study, 50 diabetic candidates (type I-25 and type II-25 patients) from Ali Ebne Abi Taleb hospital in Rafsanjan were enrolled. The control group consisted of 25 healthy subjects. The studied patients were divided into two groups according to age, sex, and weight, included 12 subjects for type I and 13 subjects for type II. Diabetic patients in both gender with clinical confirmation by the endocrinologist and the enterologist (based on clinical examination, laboratory, and immunological testing recorded in the patients' medical charts) were eligible if they did not have any other kind of syndromes (Digeorge syndrome, lupus, rheumatoid arthritis, etc.). Inclusion criteria for control group were no history of any kind of systemic diseases or local problems in oral cavity. They were chosen out of the follow-up patients with the same age and gender. Pregnancy, smoking (former and current), and chronic diseases were set as exclusion criteria as well. Institutional ethics committee at the Rafsanjan University of Medical Sciences approved the present study. Following local ethical approval (Registration number: 390049) written informed consent was obtained from all patients after they had been fully informed about the purposes of the study.
Subjects were asked not to eat or drink anything 30 min prior to saliva sample collection. They asked to spit their saliva deposit at 4 pm between 2 and 5 minutes each time for 60 s into sterile test tubes, which were given to them. Collected samples were sent to the laboratory and the measurement of the salivary IgA concentration was done using the enzyme-linked immunosorbent assay (ELISA) method and by using the Diametra (Perugia, Italy) kit.
SPSS 20.0 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) was used for all statistical analyses. Age and the level of IgA are described as mean ± standard deviation (SD) and were compared by Student's t-test between groups. Gender distribution was compared between groups using chi-square test. P < 0.05 considered to be significant.
| Results|| |
[Table 1] shows characteristics of patients with DM and control subjects. The mean of age in patients with type I diabetes was 25.2 ± 11.6 (between 11 and 56 years) and in their control group was 24.1 ± 7.9 years (between 15 and 39 years). Out of 25 patients with type I diabetes, 44% were male and 56% were female. Their control group included 25% men and 75% female. Difference between patients with type I diabetes and controls were not statistically significant (P > 0.05) in terms of gender. In patients with type II diabetes, the mean of age was 55.7 ± 9.6 (between 37 and 72 years) and in controls was 55.5 ± 10.1 (between 41 and 69 years). Out of these patients, 60% were female and 40% were male. Controls of type II diabetes were 23% female and 77% male.
|Table 1: Characteristics of patients with diabetes mellitus and control subjects|
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[Table 2] shows the mean of salivary IgA in diabetic patients and control subjects. The mean of salivary IgA in patients with type I diabetes was significantly higher than controls (P < 0.0001). The mean of salivary IgA in patients was 148.3 ± 38.7 μg/ml, but in their controls it was 65.8 ± 17.4 μg/ml. Meanwhile, in patients with type II diabetes, the mean of salivary IgA was 67.3 ± 20.6 μg/ml; whereas in controls was 63.3 ± 15.2 μg/ml. The differences between patients with type II diabetes and controls was not statistically significant (P = 0.54). The comparison of salivary IgA between patients with diabetic type I and type II is shown in [Figure 1]. The mean of salivary IgA in patients with type I diabetes was significantly higher than that of patients with type II diabetes (148.3 ± 38.7 versus 67.3 ± 20.6 μg/ml, respectively, P < 0.001).
|Figure 1: Comparison of salivary IgA between patients with type I and type II diabetes (P=0.0001). IgA = Immunoglobulin A|
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| Discussion|| |
For diagnosis and monitoring of diseases, blood sample is the most common biologic fluid utilized. An alternative for blood sample is saliva and it can be useful even for diagnostic purposes. Noninvasive collection and cost-effectiveness for screening large populations are the main advantages of salivary assessment. For diagnosis of a variety of systemic diseases and understanding of their oral manifestations, whole saliva contains locally produced substances which can be used in addition to serum components.  A variation of salivary composition in diabetic patients has been reported previously. Some studies reported significant differences in salivary IgA levels between diabetic patients and their controls, and other studies did not found such a difference. , Differences in the biologic changes in diabetic whole saliva in previous reports might be due to diversity in sample selection criteria and study design.  Results of our study showed that IgA levels in patients with type II diabetes in comparison to their controls did not have a considerable difference, though IgA levels in patients with the type I diabetics in comparison with their control groups and type II diabetics was considerably higher. In accordance to our findings, Yavuzyilmaz et al.,  reported a significant increase in salivary IgA levels in diabetic patients. Other similar study by Reuben et al.,  showed thataverage IgA levels in the type I diabetics were considerably higher than that of control group. Tenovuo et al.,  had also studied salivary immunoglobulins within the saliva of type I diabetics in comparison to a similar controlled group. They had shown that the amount of IgA and IgG in type I diabetics were considerably higher than control group.
In a study by Vaziri et al.,  differences between salivary IgA in 40 patients with type 1 diabetes, 40 patients with type 2 diabetes, and 40 healthy controls were assessed. They reported that differences in salivary IgA concentrations between type 1 and type 2 diabetic patients and their matched control subjects were not statistically significant. In another study by Branco-de-Almeida et al.,  salivary IgA levels were assessed in diabetic and nondiabetic patients with different periodontal treatment needs. In their study, salivary IgA levels were determined using an enzyme-linked immunosorbent assay and authors reported that salivary IgA levels in 54% of diabetic patients were lower than normal range and diabetic patients showed a higher variability in salivary-IgA levels as compared with nondiabetic patients. They concluded that diabetic individuals had lower salivary IgA levels, more-frequent and more-severe PD, and a greater need for periodontal treatment as compared with nondiabetic patients. A study by Lamster et al.,  has shown that patients with clinical attachment loss have lower concentrations of IgA in their gingival crevicular fluid. Other studies have shown similar results and reported that levels of total IgA reduced in patients with aggressive periodontitis compared to healthy patients. , Therefore, the idea that salivary IgA may play a protective role in the periodontium is supported by several findings. In contrast to these studies, our findings showed that the IgA level in patients with type I diabetes was higher than healthy controls. Differences in the type of saliva collected, the salivary collection methods, the stage of the disease, and the presence of PD are the possible causes of differences in findings of these studies.
In conclusion, results of the present study showed that significant differences were found in salivary IgA concentration in type I diabetics compared to control subjects and patients with type II diabetes, but there were significant differences in salivary IgA concentration in patients with type II and control subjects. Cross-sectional design and low number of patients and controls in our study are the main limitations also, since salivary IgA in the oral cavity might have some role in the development and severity of oral changes, determination and monitoring salivary constituents might be useful in the description and management of oral findings in diabetic patients. Therefore, additional well-design studies with adequate sample size will be necessary to assess salivary IgA concentration and its role in diabetic patients compared to healthy control.
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[Table 1], [Table 2]