title: Evaluation of Glycemic Control in Type 2 Diabetes Mellitus using Cytomorphometry of Buccal Cells and Correlation with Glycosylated Hemoglobin.
abstract: BACKGROUND
  To study cytological alterations in the exfoliated buccal cells of diabetic patients. To analyze the cytomorphometric findings in the smears of uncontrolled and controlled diabetic patients and compare it with that of normal healthy controls. To establish a correlation between cytomorphometric changes and glycosylated hemoglobin (HbA1c) in diabetics and normal controls, for evaluation of glycemic control.
  
  
  METHODS
  The study was carried out in 40 confirmed diabetic patients from a hospital out-patient diabetic ward and 20 healthy individuals as controls (Group A: n = 20), in Chennai. Specific exclusion criteria were used to select the study group from a larger group of subjects. Based on HbA1c values, the diabetic patients were categorized into Group B = Controlled diabetics (n = 20) (HbA1c <7%) and Group C = Uncontrolled diabetics (n = 20) (HbA1c >9%). After informed consent, buccal smear was collected from clinically normal appearing mucosa and stained with papanicoloau (PAP) stain. Cytomorphometric analysis of selective PAP stained cells was done using image analysis software, Image Pro Plus 5.5 (Olympus) and parameters determined were average cytoplasmic area (CA), average nuclear area (NA) and cytoplasmic:nuclear (C: N) ratio for an average of 50 cells/patient.
  
  
  RESULTS
  Comparing the average NA among three groups, an increase through Group A, B, C, with a maximum significance between Group C and A was seen. The average C: N ratio showed a statistically significant difference between all three groups. Significant correlation existed between the HbA1c values and both the C: N ratio and average NA in all the three groups.
  
  
  CONCLUSIONS
  Cytomorphometric analysis of buccal smears using the C: N ratio alteration as a reliable criteria, may serve as yet another non-invasive tool for screening programs for diabetic detection. And the technique may possibly be used also for evaluation of glycemic control in known diabetics.
authors: Reader, Department of Oral Pathology, SRM Dental College, Chennai, Tamil Nadu, India.
authors: K Raghavendhar
authors: KR
authors: Karthik
authors: Professor and Head, Department of Oral Pathology, Sri Ramachandra Dental College, Chennai, Tamil Nadu, India.
authors: N
authors: N
authors: Malathi
authors: Oral Physician and Radiologist, Radiant Smile Care, Chennai, Tamil Nadu, India.
authors: K
authors: K
authors: Poornima
authors: Post-graduate Student, Department of Oral Pathology, SRM Dental College, Chennai, Tamil Nadu, India.
authors: Sunil
authors: S
authors: Prakash
authors: Senior Lecturer, Department of Periodontics, Sri Venkateshwara Dental College, Chennai, Tamil Nadu, India.
authors: R
authors: R
authors: Kadhiresan
authors: Professor, Department of Periodontics, Sri Venkateswara Dental College, Chennai, Tamil Nadu, India.
authors: U
authors: U
authors: Arunmozhi
keywords: Cytomorphometry; diabetes mellitus; exfoliative cytology; glycemic control