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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE- II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1
NAME OF THE CANDIDATE
DR.SHOBHA NAIK
AND ADDRESS (in block letters)
P.G STUDENT
THE OXFORD DENTAL COLLEGE
BOMMANAHALLI, HOSUR ROAD
BANGALORE-560068
2
NAME OF THE INSTITUTION
THE OXFORD DENTAL COLLEGE
HOSPITAL
AND
RESEARCH
CENTER, BANGALORE.
3
COURSE
OF
THE
AND SUBJECT
STUDY MASTER OF DENTAL SURGERY,
DEPARTMENT
OF
ORAL
MEDICINE AND RADIOLOGY
4
DATE OF ADMISSION TO MAY 2010
COURSE
5
TITLE OF THE TOPIC
EVALUATION & COMPARISON OF
TASTE PERCEPTION AMONG
DIABETES MELLITUS TYPE 2
PATIENTS & HEALTHY
CONTROLS
6
BRIEF RESUME OF INTENDED WORK
6.1
NEED FOR THE STUDY
Gustation is an important chemical sense & its disturbance , i.e
dysgeusia can be very distressing .Taste allows a person to select food in
accordance with the desires & needs of the host for specific nutritive
substance.The human gustatory system recognizes many different taste stimuli ,
which can be classified as 4 taste qualities : sweet , salty, sour, & bitter .Taste is
mainly a function of taste buds in mouth. Taste is adversely affected in diabetes
patients1.
Diabetes mellitus is a clinically & genetically heterogenous metabolic
disease
characterized
by
abnormally
elevated
blood
glucose
levels
(hyperglycemia) & dysregulation of carbohydrate , protein , & lipid metoblism.
The primary feature of this disorder is chronic hyperglycemia , resulting from
either a defect in insulin secretion from the pancreas or resistance of the body’s
cells to insulin action .2 Extensive clinical & experimental literature documents
a variety of alterations in taste function associated with diabetes mellitus.2
There is a significant & specific impairment in sweet taste detection in
diabetes mellitus Type 1 & Type 2 patients . Although the pathophysiology of
taste disorders remain unclear in diabetes patients , an association between taste
impairment & diabetic neuropathies has been described in previous studies.
Previous studies reported a direct affect of blood glucose concentration on taste
. However, some investigators found no correlation between taste & either the
plasma glucose or glycosylated hemoglobin.3
Few studies have been performed to determine the
alteration of
gustatory function in diabetes mellitus type 2. The results of the limited number
of studies are contradictory in some aspects , thus suggesting the need for
further evaluative studies.
The present study will be under taken to evaluate & compare taste perception
among controlled & uncontrolled diabetes mellitus type 2 patients & healthy
subjects
6.2 REVIEW OF LITERATURE
A study was done to evaluate the gustatory function of 40 controlled diabetes
mellitus & 40 uncontrolled Type 2 diabetes mellitus patients, with age &
gender matched healthy controls. Gustatory function was tested by
administering a whole mouth above threshold test & spatial taste(to compare
gustatory appreciation on right & left sides of tongue & soft palate) using
sucrose , sodium chloride, citric acid , & quinine hydrochloride solutions.
Results showed impaired taste sensation in 80% of uncontolled diabetes
patients & nearly 50% of controlled diabetic patients compared with controls.
Author concluded that there was blunted taste response among uncontrolled
diabetes patients for sweet followed by sour & salt taste.This taste abnormality
may influence the choice of nutrients , with a preference for sweet–tasting
foods , there by exacerbating hyperglycemia. 3
A study was conducted to assess olfactory & gustatory function in 76
patients with Type 1&2 Diabetes mellitus with & without accompanying
diseases & 29 healthy subjects.Taste function was tested by means of
impregnated paper taste strips & smell function was screened using a five- item
smell identification test . The results showed no significant difference in taste &
smell function between patients with uncomplicated DM & healthy controls.
However, patients with additional diseases exhibited decreased smell acuity.
Patients with Type 2 diabetes mellitus showed impaired smell function
compared with Type 1 diabetes mellitus patients. 4
Another study was done to assess gustatory appreciation in
20 newly
diagnosed NIDDM patients compared with 20 non diabetic controls & to
determine taste alteration with the improvement of glycemic control after
treatment with diet & oral hypoglycemic drugs .Assesment of taste, peripheral
& autonomic neural function , diet was done. The electric taste thresholds ,
detection threshold for glucose & salt were increased in newly diagnosed
NIDDM patients . These patients had blunted taste response, specifically to
glucose , which partially reversed after correction of hyperglycemia & is
independent of somatic or autonomic nerve function . Authors concluded that
taste abnormality may influence the premorbid choice of nutrients , with
preference for sweet tasting foods , there by exacerbating hyperglycemia .5
Another study was done on taste impairment in 57 Type 1 diabetes
mellitus patients & 38 controlled subjects with electrogustometry & chemical
gustometry.Four primary taste were involved in taste impairment,taste disorders
were related to diabetic status , tobacco & alcohol .In the diabetic group , taste
impairment of sweet,sour & bitter
was significantly associated with
complication of the disease .6
A study was done to determine whether a generalized defect in glucose
recognition exists in diabetes, taste detection & preference were measured in
adult onset diabetics (AOD), juvenile onset (JOD) & healthy first degree
relatives of diabetics (NR) ,controls (C) were age & sex matched non diabetics
without first degree diabetic relatives.The AOD & NR groups showed
significantly higher glucose thresholds than their controls. Incontrast , glucose
threshold in JOD was not different from C. The AOD group also demonstrated
a higher sucrose threshold than C. No difference in salt detection was seen in
any of the groups.No significant difference in glucose or sucrose preference
were noted , but both AOD & NR groups preferred lower salt concentration
than C. These findings indicate that there may be a widespread impairment of
cellular glucose recognition in AOD & their relatives.7
6.3 OBJECTIVES OF THE STUDY
1. To evaluate the gustatory functions of patients with Type 2 diabetes
mellitus & Healthy controls .
2. To compare the gustatory functions between Type 2 controlled diabetes
mellitus & Uncontrolled diabetes mellitus patients & healthy subjects.
3. To correlate gustatory function with duration of disease .
7
MATERIALS AND METHODS
7.1 SOURCE OF DATA
30 patients with diabetes mellitus (15 controlled diabetes mellitus, 15
uncontrolled diabetes mellitus ) & 15 healthy controls (free from systemic
disease) will be selected from among the out patients attending the Department
of Oral Medicine and Radiology, The Oxford Dental College and Research
Center, Bangalore.
7.2 METHOD OF COLLECTION OF DATA
The study design will be explained to the patient & consent will be obtained on
the consent form. Each subject is requried to complete a questionnaire
regarding self assessment of taste. A data of medications & duration of the
disease will be recorded.Glycosylated hemoglobin concentration , random
blood glucose level & hemoglobin concentrations will be measured.
All subjects will be given a form with clearly identified tastes & a scale
ranging from 1 to 5 (weakest to strongest ) for concentrations of each taste
solutions.The subjects were asked to identify the taste & mark accordingly on
the given scale.
For testing gustatory function , two different tests will be administered,
whole mouth , above threshold taste test & spatial (localised) taste test. For
this purpose ,five concentration levels of solutions sucrose (sweet ) , citric
acid (sour ), quinine hydrochloride (bitter), sodium chloride (salt) will be used.
Five concentration levels (in 0.5 log steps) of NaCL(0.01 to 1.00mol/L), citric
acid (0.320 to 0.032mol/L), quinine hydrochloride (0.01 to 1.00 mmol/L) &
sucrose (0.01 to 1.00mol/L) will be used in this study.
In the whole mouth above threshold taste test , subjects will be presented
5ml of taste solution & will be instructed to sip , swish for approximately 10
seconds & then expectorate the sample. The subjects will be asked to identify
the quality (salty, sour , bitter, sweet) & the intensity of taste solution. If the
subject is unable to identify the taste , another row with the next higher
concentration of the taste solution will be presented.This solution concentration
will be taken to represent the detection threshold & it will be recorded by
scoring the lowest concentration as 1 & highest concentration as 5 . The same
procedure will be carried out for the rest of all solution & the quality &
intensity judgment will be recorded . A distilled water rinse will preceed each
presentation of taste solution cup.
In the spatial (localized ) taste test , each subject will be examined for
localized taste function.This test consist of identifying the quality of each test
stimulus & rating it on an intensity scale from 0 (no taste) to 9 (very strong
taste). In each trial , the strongest concentration of 1 to 4 solutions used in the
previous technique will be painted with a cotton swab onto 6 different
locations in the mouth : the left & right anterior & posterior-lateral surfaces of
the tongue & the 2 sides of the soft palate , lateral to midline. The stimulus
presentation will be approximately of 5 seconds & taste intensity score will be
recorded. The same procedure will be performed for all taste solutions with
application of distilled water swab before each taste test .3
INCLUSION CRITERIA
1. Patients with diabetes mellitus Type 2 between the age group of 25 to
55 years.
2. Age and sex matched healthy individuals
without history of any
systemic disease.
EXCLUSION CRITERIA
1. Diabetes mellitus patients with associated
symptoms of peripheral
neuropathy & other complications.
2. Diabetes mellitus patients with other systemic diseases.
3. Patients with any lesions on tongue & mucosa.
4. Pregnant patients.
7.3 Does the study require any investigations or interventions to be
conducted on patients or other humans or animals?
Yes
7.4 Has ethical clearance been obtained from your institution in case of
7.3?
Yes
8 . LIST OF REFERENCES:
1. Lynch ,Brightman, Greenberg, Burket’s Oral Medicine. 9th ed .
Philadelphia:Lippincott- Raven ;1998. p.343-65
2. Greenberg, Glick, Ship, Burket’s Oral Medicine .11th ed. NewYork :
BC Decker Inc ; 2008. p.510-11.
3. Gondivkar SM , Indurkar A , Degwekar S, Bhowate R . Evaluation
of gustatory functions in patients with diabetes mellitus Type2 .Oral
pathology oral medicine oral radiology & oral endodontology
2009;108(6): 876- 80
4. Naka Asami, Luger A, Riedl M , Hummel T, Muller CA .
Clinical significance of smell & taste disorders in patients with
diabetes mellitus . Eur Arch otorhinolaryngol 2010; 267 : 547 -50
5. Perros P , Counsel C , MacFarlane TW, Frier BM .Altered taste
sensation in newly diagnosed NIDDM . Diabetes care 1996;19: 76870
6. Le Floch JP, Lievre GL, Sadoun J, Leon P, Peynegre R, Hazard J
.Taste impairment & related factors in Type 1 diabetes
mellitus.Diabetes care.1989;12:3
7. Lawson WB, Zeidler A, Rubenstien A.Taste detection & preferences
in Diabetes & their relatives.Psychosomatic medicine .
1979;41(3):219-27
9
Signature of the Candidate
10
Remarks of the Guide
11
Name & Designation of
11.1
Guide
Dr. Sujatha.D
Professor
Dept Of Oral Medicine and Radiology
11.2 Signature
11.3
Head of Department
Dr. K.S .Ganapathy
Professor and HOD
Dept Of Oral Medicine and Radiology
11.4 Signature
12
Remarks of the Chairman &
Principal
Dr. K.S. Ganapathy
Professor and HOD
Dept Of Oral Medicine and Radiology
12.1
Signature