Comparative Evaluation of Glucose Levels in Gingival Crevicular Blood and Peripheral Blood Using Two Different Glucometers in Patients Suffering From Periodontal Disease

TL;DR

This study compares glucose levels in gum blood and finger blood using two glucometers, finding that gum blood can be as reliable for diabetes screening in dental settings.

Contribution

The study demonstrates that gingival crevicular blood can be used as an accurate, noninvasive alternative to peripheral blood for glucose monitoring in dental clinics.

Findings

GCB glucose levels showed no significant systematic bias compared to venous blood when measured with glucometer A.

Both glucometers showed strong agreement in estimating glucose levels from GCB and peripheral blood.

GCB can be used as a reliable source for noninvasive glucose monitoring in dental settings.

Abstract

Introduction: Given dentists' increasing role in healthcare, dental clinics may be essential sites for diabetes screening. Gingival bleeding is a hallmark of periodontal inflammation. Gingival crevicular blood (GCB) collection with a portable glucometer for glucose measurement is a safer, more convenient, patient-friendly, and time-saving option. The primary objective of the current investigation was to compare random blood glucose levels with those in gingival crevicular and peripheral blood, as determined using two different glucometers. The study's secondary goal was to assess the feasibility and inter-glucometer agreement of estimating blood sugar from gingival crevicular blood using a glucometer as a chairside diabetes screening tool.

Methods: The present study included 85 patients with bleeding during probing in the maxillary anterior region. The GCB sample was collected from an appropriate site of the maxillary anterior teeth. Peripheral blood (PB) samples were collected from the patients' right index fingers to determine PB glucose levels. Blood glucose levels were measured using glucometers from two different brands: Dr. Morepen (A) and Contour Plus (B). Venous blood samples were used to determine random blood sugar (RBS) level using laboratory methods. The data were divided into five groups: GCB A: GCB evaluated by glucometer A; GCB B: GCB evaluated by glucometer B; PB A: PB evaluated by glucometer A; PB B: PB evaluated by glucometer B; and RBS: random blood sugar.

Bland-Altman analysis was used for intergroup comparisons. Concordance correlation analysis across groups was performed to assess the concordance between two variables. Intraclass correlation was used to assess absolute agreement among the different methods of blood glucose measurement. A p-value of less than 0.05 was considered significant.

Results: The present study comprised 85 participants. The participants' ages ranged from 15 to 70 years. The majority, 53 (62.4%) of the participants, were male. Almost 94% (n=80) of the participants were normoglycemic. The mean glucose level was highest in the PB group (102.68 mg/dL) and lowest in the GCB B group (99.58 mg/dL). There was no significant systematic bias between GCB A with RBS (mean difference = -0.23, 95% CI: -2.22 to 1.77) and PB B (mean difference = 0.09, 95% CI: -1.84 to 2.02), whereas PB A exhibited systematic overestimation. Furthermore, RBS (mean difference=0.88, 95% CI: -0.91 to 2.66), PB B (mean difference=1.20, 95% CI: -0.60 to 3.00), and GCB A (mean difference=1.11, 95% CI: -0.42 to 2.63) are less biased than GCB B. Both GCB A and GCB B showed significant concordance with RBS, PB A, and PB B (correlation coefficients >0.95, p-values <0.001).

The two glucometers under study showed almost perfect absolute agreement in estimating blood sugar levels from gingival crevicular blood (ICC single-measure value > 0.9) and peripheral blood (single-measure value > 0.9).

Conclusion: GCB oozing from periodontal pockets during routine examination may be used for glucose estimation as precisely as that from peripheral and venous blood. There is no statistically significant difference in glucose estimation results obtained with the two glucometers used in the study. GCB can serve as a source for noninvasive glucose monitoring in a dental setting.

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