Analysis on Serum and Salivery Glucose Level in Diabatic Patients

Diabetes mellitus is a gathering of complex multisystem metabolic scatters portrayed by relative or total deficiency of insulin emission as well as associative protection from the metabolic activity of insulin on target tissues.1 The overall blast of this incessant illness is a noteworthy human services trouble. The quantity of individuals all inclusive with diabetes are anticipated to ascend to 439 million (7.7%) by 2030.2 Currently, India has 41 million diabetics, and this number is relied upon to increment to 70 million by 2025. The expanded number of diabetics in India is likely because of remarkable rates of urbanization and way of life changes.3 The expanded dreariness and mortality of diabetic patients is for the most part credited to confusions of the illness. Hyperglycemia is the quick metabolic outcome of diabetes, and incessant hyperglycemia prompts a few occasions that advance basic changes in tissues.1,4 A high predominance of wide range oral modifications related with diabetes has been portrayed in writing. To limit the danger of complexities related with this ailment, it is important to routinely screen the glucose levels of diabetic patients. The essential angle in glycemic control is the successive observing of blood glucose levels.5 Various biofluids that are utilized to screen glucose levels incorporate blood and pee. The decision of blood as an analytic liquid for clinical testing is obvious considering its cozy relationship to the homeostasis of the body. Since blood courses all through all organs, its concoction cosmetics is a composite of about every metabolic procedure happening in the person. In any case, blood accumulation is an intrusive system and makes fleeting inconvenience the subject.6 Thus there emerges a requirement for noninvasive procedure for checking glycemic control in diabetics. In the previous 2 decades the greater part of the exploration is based on foundation of a noninvasive strategy for glycemic control.7 An endeavor to control blood glucose by checking urinary glucose has the upside of being noninvasive. The control accomplished, be that as it may, is just estimated and the estimation of pee tests is confined by the renal edge to glucose which shifts significantly between patients.8 Since 2002, The National Institute of Dental and Craniofacial Research made chances to defeat these constraints by examining oral liquids as a demonstrative device for the appraisal of wellbeing and sickness status.9 Saliva satisfies a few of the boss indicative worries for a symptomatic biofluid as it is gotten noninvasively, and its accumulation requires no exceptional expertise. Due to the simplicity, wellbeing, and ease of spit accumulation, its guarantee for present and future diagnostics warrants uncommon consideration.6 To date few investigations have been performed on salivary arrangement and capacity in diabetic patients especially in India. There are clashing outcomes on the utility of spit as a demonstrative device for checking diabetes in the English writing. In this way, the point of the present examination was to set up salivation as a symptomatic instrument for observing glycemic control in diabetic patients.

The prevalence of diabetes is rapidly rising wherever all through the globe at an irritating rate.18 Over the span of the last 30 yrs, the status of diabetes has changed from being considered as a smooth issue of the elderly to one of the genuine explanations behind inauspiciousness and mortality affecting the youthful extension in the inescapability of sort 1 diabetes in like manner, the genuine driver of the pandemic is the more run of the mill kind of diabetes, particularly sort 2 diabetes, which speaks to more than 90 for every penny of all diabetes cases. No place is the diabetes torment more explained than in India as the World Health Organization (WHO) reports show that 32 million people had diabetes in the year 2000. The International Diabetes Federation (IDF) assesses the total number of diabetic subjects to be around 40.9 million in India and this is furthermore set to climb to 69.9 million by the year 2025.20 The fundamental national examination on the inescapability of sort 2 diabetes in India was done in the region of 1972 and 1975 by the Indian Council Medical Research (ICMR, New Delhi).4 Screening was done in around 35,000 individuals more than 14 yr of age. The regularity was 2.1per penny in urban people and 1.5 for each penny in the commonplace masses while in those more than 40 yr of age; the inescapability was 5 for each penny in urban and 2.8 percent in rural areas.21 Resulting examinations showed a rising example in the prevalence of diabetes transversely finished different parts of India. In 1988, an examination done in a little township in south India uncovered a regularity of 5 percent.22 A national commonplace diabetes review was done in the region of 1989 and 1991 in different parts of the country in picked nation peoples. This examination which used the 1985 WHO criteria to dissect diabetes, uncovered a harsh ordinariness of 2.8 for each cent.23 An examination done in 1988 in Chennai declared a transcendence of 8.2 for each penny in the urban and 2.4 for every penny in the commonplace areas.24 A resulting report in the same urban zone done after five years exhibited an age organized regularity of 11.6 for each penny demonstrating a rising example in inescapability of diabetes.25 A high inescapability of 16.3 for every penny was represented in Thiruvananthapuram in Kerala State in the year 1999.10 Around a similar time, a power of 8.2 for each penny was represented from Guwahati. A cross-sectional people outline was done in the Kashmir valley in 2000 and the inescapability of 'known diabetes' among adults developed >40 yr was seen to be 1.9 percent.26 The enthusiastic rising in the prevalence of sort 2 diabetes and related issue like heaviness, hypertension and the metabolic issue could be related to the quick changes in lifestyle that has occurred in the midst of the last 50 yr. Regardless of the way that this "epidemiological change", which fuses improved sustenance, better cleanliness, control of various transmittable illnesses and upgraded access to quality human administrations have realized extended life expectancy. It has moreover provoked the quick climb The intrusion of western culture into the lives of customary indigenous gatherings has also had crushing achieves terms of the climb in diabetes and related metabolic issue. In basically all masses, higher fat eating regimens and lessened physical activity and dormant word related penchants have ran with the method of modernization which has achieved the duplicating of the inescapability of huskiness and sort 2 diabetes in less than an age. The 'fast food culture' which has overwhelmed our urban ranges and towns is in like manner a significant driver of the diabetes torment. The 'snappy sustenances' that are fat and calorie rich are easily available in the different support joints. As a bigger piece of the specialists in Indian urban communitiesn rely upon these undesirable 'garbage' sustenances, this might be a main consideration in the rising commonness of diabetes and cardiovascular maladies in urban slums.26 Urban common differences in the prevalence of diabetes have been dependably reported from India. ICMR look at (1972-1975) uncovered that the prevalence was 2.1 for every penny in urban and 1.5 for every penny in commonplace zones, a later report showed that the inescapability was three times higher among the urban (8.2%) stood out from the provincial people 2.4%).24 An examination done in southern Kerala looked assortments in the normality of sort 2 diabetes among different geographic divisions inside a region.21 The inescapability of diabetes was the most raised in the urban (12.4%) locales, trailed by the midland (8.1%), great nation (5.8%) and shoreline division (2.5%).27 The inescapability of diabetes is by and by rapidly extending among the poor in the urban ghetto occupants, the cushy class and even in the rural areas. This is a result of quick changes in physical activity and dietary affinities even among the poorer ranges of the society.28 The early unmistakable confirmation of in threat individuals and fitting intercession as weight reducing, changes in dietary penchants and extended physical development could fantastically balance, or if nothing else delay, the start of diabetes and along these lines decrease the weight due to non-transferable diseases in India.26

Diabetes mellitus is a social occasion of metabolic sicknesses depicted by hyperglycemia happening due to deformations in insulin release, insulin action, or both. The perpetual hyperglycemia of diabetes is connected with whole deal hurt, brokenness, and frustration of various organs, especially the eyes, kidneys, nerves, heart, and veins.

pancreas with security from insulin action. The introduce of the varieties from the standard in starch, fat, and protein absorption in diabetes is lacking movement of insulin on target tissues. Lacking insulin movement comes to fruition due to insufficient insulin release and also decreased tissue responses to insulin no less than one concentrations in the complex pathways of hormone action. Shortcoming of insulin discharge and defects in insulin action a great part of the time concur in a comparable patient, and it is often dim which variety from the standard, if either alone, is the basic driver of the hyperglycemia. Four polypeptides with hormonal activity are released by the islets of Langerhans in the pancreas, to be particular insulin, glucagon, somatostatin and pancreatic polypeptide. The A cells release glucagon, B cells insulin, D cells somatostatin and F cells radiate pancreatic polypeptide.

Glycogen is a type of put away glucose that the body utilizes as a vitality source. Glycogen stockpiling malady (GSD) includes deserts that reason an anomalous amassing of glycogen, generally found in the liver, muscle, or both. At the point when gathering happens in the liver glycogen stockpiling sicknesses result in liver amplification and conditions going from gentle hypoglycemia to liver disappointment. At the point when the gathering happens in muscle, glycogen stockpiling illnesses result in conditions running from trouble practicing to cardiovascular and respiratory disappointment.

Glucose is a fundamental sugar that limits as an essential essentialness hotspot for most genuine limits. Glucose can be increased through the eating regimen or formed inside the considerable cells. Levels of glucose in the blood are kept up in a glucose. Hormones, for instance, insulin, help the removal of glucose from the blood and into cells to be used as imperativeness. Excess glucose is collected as glycogen as a kind of successfully gathered essentialness accumulating for use when sustenance isn't plentiful. To be sure, even while napping, glycogen stores are open to keep up blood glucose levels and essentialness until the end of time. The system of the improvement of glycogen sheets is named glycogenesis, and is enabled by hormones, for instance, insulin. The technique of the breakdown of sheets of glycogen into usable glucose is named glycogenolysis, and is moreover under tight control. Hormones that strengthen glycogenolysis control mixes to oust only the crucial measure of glucose from glycogen stores. With an ordinary step by step sustenance affirmation, glycogen stores are continually being produced and isolated in perspective of the necessities of the body. Ordinary glycogen stores fill in as a short lived supply of glucose, and ought to be reestablished step by step. Glycogen fills in as imperativeness storing in every organ, yet the liver and skeletal muscles are the rule districts of glycogen explanation. The cerebrum is penniless upon glucose for essentialness, in this manner requires a particular level of blood glucose to be available continually. Since the mind has just insignificant glycogen stores, it is fundamentally reliant on glycogen from different organs, for example, the liver. Glycogen has seclude works in liver and muscle. Muscle uses glycogen as a fuel source with which to convey essentialness in the midst of activity. As muscle is being used, glycogen stores are being isolated into glucose, changed into cell imperativeness called ATP, and depleted. In the liver, glycogen is primarily used as an upkeep imperativeness hotspot for the entire body, and is responsible for keeping blood glucose levels in an enduring extent. After ingestion of dietary glucose, the liver takes up various support breakdown things from the circulatory framework, changes over them into glucose, and stores them as glycogen. Eventually after a dinner, when blood glucose levels typically fall, the liver uses its glycogen stores to revive the blood with glucose. Organs that can't make enough glycogen of their own are in like manner gave. Glycogen storing contaminations may incorporate betrays in glycogen breakdown or plan in muscle, liver, or both muscle and liver. Some extraordinary features of GSDs that fundamentally incorporate muscle can't avoid being muscle issues, hone intolerance, and basic fatigability. Some model features of GSDs that primarily incorporate liver can't sorts of GSD that incorporate particular flaws in glycogen use. The sorts of GSD that are best depicted are sorts I through VIII, each with an unmistakable name and Glycogen is the focal accumulating kind of free (glucose) in animal cells, in any case it is also found in various sorts of microorganisms, for instance, organisms and fish. It is a broad, fanned polymer of associated glucose stores (sections of greater particles) that can be expeditiously gathered as an essentialness source, extending the measure of glucose immediately open to the animal 29 in the midst of solid development. Since the mind depends on glucose as its favored fuel, the capacity to keep up an unfaltering supply of glucose, which is the real sugar circling in the blood of higher creatures, is significant to survival. Glycogen is found as granules in the cytosol, the inside fluid of the cell. Around three-fourths of the body's glycogen supply is secured in muscle cells. In any case, liver cells (hepatocytes) have the most shocking gathering of glucose (a biggest of around eight percent in liver versus one percent of the main part of an adult male individual). Little measures of glycogen are moreover found in the kidneys, and fundamentally humbler entireties in certain glial cells in the cerebrum and in white platelets. The physiological piece of glycogen depends upon the sort of cell in which it is stored.31 ● Liver cells accept a key part in coordinating the blood glucose level as they can either isolate glycogen (glycogenolysis) to release glucose into the blood or draw back glucose from the blood and store it by incorporating glycogen (glycogenesis). It is vital that glucose isn't an essential fuel for the liver, which generally utilizes keto acids. The liver cells, in this way, play out the glucose accumulating and release in a general sense for the benefit of various organs. This mirrors the administer of twofold purposes, whereby the parts of living animals collaborate concordantly in light of the way that they not simply demonstrate an individual reason arranged toward their own self-upkeep and change, yet furthermore fill a requirement for the sum. ● In skeletal muscle, glycogen is an essentialness hold that can be tapped in the midst of work out. Muscle cells don't have the ability to release glucose into the blood, so their glycogen store is destined for internal use, driving muscle withdrawal in the midst of strenuous activity. Glycogen-storing issue are a kind of obtained metabolic disease coming to fruition due to absences of the proteins that share in glycogen processing. Side cardio-respiratory disappointment or liver disappointment in influenced babies.

Since there is preanalytic and expository changeability of the considerable number of tests, it is additionally conceivable that when a test whose outcome was over the indicative edge is rehashed, the second esteem will be underneath the symptomatic cut point. This is most outlandish for A1C, to some degree more probable for FPG, and in all probability for the 2-h PG. Notwithstanding a research facility mistake, such patients are probably going to have test comes about close to the edges of the limit for a determination. The human services proficient may pick to take after the patient intently and rehash the testing in 3– 6 months.

Following table is suggestive of increased risk for diabetes FPG 100–125 mg/dl (5.6–6.9 mmol/l) [IFG] 2-h PG on the 75-g OGTT 140–199 mg/dl (7.8–11.0 mmol/l) [IGT] A1C 5.7–6.4%. For all three tests, risk is continuous, extending below the lower limit of the range and becoming disproportionately greater at higher ends of the range.

The criteria for abnormal glucose tolerance in pregnancy are those of Carpenter and Coustan. Recommendations from ADA's Fourth International Workshop-Conference on Gestational Diabetes Mellitus held in March 1997 support the use of the Carpenter/Coustan diagnostic criteria as well as the alternative use of a diagnostic 75-g 2-h OGTT. These criteria are summarized below.

Past proposals included screening for GDM performed in all pregnancies. Nonetheless, there are sure factors that place ladies at bring down hazard for the advancement of glucose bigotry amid pregnancy, and it is likely not practical to screen such patients. Pregnant ladies who satisfy these criteria require not

● are <25 years old ● are an ordinary body weight ● have no family history (i.e., first-degree relative) of diabetes ● have no history of anomalous glucose digestion ● have no history of poor obstetric result ● are not individuals from an ethnic/racial gathering with a high pervasiveness of diabetes (e.g., Hispanic American, Native American, Asian American, African American, Pacific Islander) Hazard evaluation for GDM ought to be embraced at the main pre-birth visit. Ladies with clinical qualities reliable with a high danger of GDM (checked corpulence, individual history of GDM, glycosuria, or a solid family history of diabetes) ought to experience glucose testing (see underneath) as fast as achievable. In the event that they are found not to have GDM at that underlying screening, they ought to be retested in the vicinity of 24 and 28 weeks of incubation. Ladies of normal hazard ought to have testing attempted at 24– 28 weeks of growth. A FPG level >126 mg/dl (7.0 mmol/l) or an easygoing plasma glucose >200 mg/dl (11.1 mmol/l) meets the edge for the conclusion of diabetes. In the insufficiency of unequivocal hyperglycemia, the determination must be affirmed on a resulting day. Affirmation of the finding blocks the requirement for any glucose challenge. Without this level of hyperglycemia, assessment for GDM in ladies with normal or high-hazard qualities ought to tail one of two methodologies.

Play out a scientific OGTT without prior plasma or serum glucose screening. The one-propel approach may be canny in high-chance patients or peoples (e.g., some Native-American social affairs).

Play out a basic screening by measuring the plasma or serum glucose obsession 1 h after a 50-g oral glucose stack (glucose challenge test [GCT]) and play out a symptomatic OGTT on that subset of women outperforming as far as possible a motivating force on the GCT. Right when the two-propel approach is used, a glucose constrain regard >140 mg/dl (7.8 mmol/l) With either approach, the assurance of GDM relies upon an OGTT. Demonstrative criteria for the 100-g OGTT are gotten from the main work of O'Sullivan and Mahan. Modified through Carpenter and Coustan and are exhibited as takes after. Then again, the finding can be made using a 75-g glucose stack and the glucose edge regards recorded for fasting, 1 h, and 2 h base, in any case, this test isn't excessively endorsed as the 100-g OGTT.41

● Testing to recognize sort 2 diabetes and survey hazard for future diabetes in asymptomatic individuals ought to be considered in grown-ups of all ages who are overweight or fat (BMI ≥25 kg/m2) and who have at least one extra hazard factors for diabetes. In those without these hazard factors, testing should start at age 45 years. ● If tests are ordinary, rehash testing ought to be done at any rate at 3-year interims. ● To test for diabetes or to survey danger of future diabetes, either A1C, FPG, or 2-h 75-g OGTT are proper. ● In those related to expanded hazard for future diabetes, recognize and, if suitable, treat other CVD chance components. Criteria for testing for diabetes in asymptomatic grown-up people 1. Testing ought to be considered in all grown-ups who are overweight (BMI ≥25 kg/m2) and have extra hazard factors: ● Physical idleness ● First-degree relative with diabetes ● Members of a high-hazard ethnic populace (e.g., African American, Latino, Native American, Asian American, Pacific Islander) ● Women who conveyed an infant measuring >9 lb or were determined to have GDM ● Hypertension (≥140/90 mmHg or on treatment for hypertension) ● Women with polycystic ovary disorder ● A1C ≥5.7%, IGT, or IFG on past testing ● Other clinical conditions related with insulin protection (e.g., extreme weight, acanthosis nigricans) ● History of CVD 2. In the nonappearance of the above criteria, testing diabetes should start at age 45 years 3. If outcomes are ordinary, trying ought to be rehashed at any rate at 3-year interims, with thought of more incessant testing relying upon introductory outcomes and hazard status.

For some ailments there is a noteworthy qualification amongst screening and symptomatic testing. In any case, for diabetes similar tests would be utilized for "screening" concerning analysis. Sort 2 diabetes has a long asymptomatic stage and vital clinical hazard markers. Diabetes might be distinguished anyplace along a range of clinical situations going from an apparently generally safe person who happens to have glucose testing, to a higher-hazard person who the supplier tests in light of high doubt of diabetes, to the symptomatic patient. The discussion here in is fundamentally confined as testing for diabetes in people without side effects. Testing for diabetes will likewise recognize people at expanded future hazard for diabetes, here in alluded to as pre-diabetic.

Sort 2 diabetes is as frequently as conceivable not investigated until the point that the moment that disarrays show up, and around one-fourth shockingly with diabetes in the U.S. may be unfamiliar. Disregarding the way that the ampleness of early ID of pre-diabetes and diabetes through mass testing of asymptomatic individuals has not been shown convincingly (and careful trials to give such affirmation are presumably not going to happen), pre-diabetes and diabetes get set together criteria for conditions in which early acknowledgment is reasonable. The two conditions are typical, are extending in inescapability, and power gigantic general prosperity loads. There is a long presymptomatic stage before the assurance of sort 2 diabetes is regularly made. Respectably Additionally, the length of glycemic inconvenience is a strong marker of opposing outcomes, and effective intercessions exist to neutralize development of pre-diabetes to diabetes. Following are the proposition for testing for diabetes in asymptomatic unfamiliar adults .Testing should be considered in adults of any age with BMI ≥25 kg/m2 and no less than one danger factors for diabetes. Since age is a vital peril factor for diabetes, testing of those without other risk factors should begin no later than at age 45 years. ● The fitting break between tests isn't known. The technique for thinking for the 3-year interval is that false negatives will be repeated before liberal time sneaks past, and there is little likelihood that an individual will make important complexities of diabetes inside 3 years of a negative test result. ● Because of the necessity for improvement and discourse of unpredictable results, testing should be done inside the social protection setting. Gathering screening outside a restorative administrations setting isn't recommended in light of the way that people with constructive tests may not search for, or approach, reasonable follow-up testing and care. On the other hand, there may be powerlessness to ensure appropriate repeat testing for individuals who test hostile. Gathering screening may in like manner be insufficiently centered around, i.e., it may disregard to accomplish the social affairs most in threat and shamefully test those at for the most part protected (the focused on well) or even those starting at now broke down.

● The event of sort 2 diabetes in youngsters has extended radically in the latest decade, especially in minority peoples, regardless of the way that the ailment remains unprecedented in the general pediatric masses. Reliable with proposals for grown-ups, youngsters and youth at expanded hazard for the nearness or the advancement of sort 2 diabetes ought to be tried inside the social insurance setting. The suggestions of the ADA agreement proclamation on sort 2 diabetes in kids and youth, with a few adjustments, are abridged here.

Criteria: Overweight (BMI >85th percentile for age and sex, weight for height >85th percentile, or weight >120% of ideal for height)

second-degree relative following risk Race/ethnicity (Native American, African American, Latino, Asian factors: American, Pacific Islander) Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome, or small for gestational age birth weight) Maternal history of diabetes or GDM during the child's gestation Age of initiation: Age 10 years or at onset of puberty, if puberty occurs at a younger age Frequency: Every 3 years

The exceptionally noteworthy connection was found amongst serum and salivary levels of glucose, amylase, add up to proteins, egg whites and globulin in DM patients while on intergroup examination, critical relationship was found amongst diabetics and non-diabetics for salivary glucose, amylase, calcium and phosphorous. Subsequently, exhibit study will include new measurements and establish the framework for additionally inquire about on extensive populaces in making utilization of salivary biochemical parameters (glucose, amylase, calcium, phosphorus) for screening, determination and observing of DM to blood.

Ahuja M. M. S. (1979). Epidemiological studies on diabetes mellitus in India. In: Ahuja MMS, editor. Epidemiology of diabetes in developing countries. New Delhi: Interprint; pp. 29-38. American Diabetes Association consensus on self-monitoring of blood glucose diabetes care 1987 ; 10 : pp. 95-9. Harris MI,Cowie CC,Howie LJ. Berry H. Ginsberg (1992). Less invasive technology. Clin Chem 1992; 38(9) : pp. 1596-1600. BH Ginsberg (1992). An overview of minimally invasive technologies. Clin Chem; 38(11): pp. 2360. C. O. Reuterving, G. Reuterving, E. Hagg, and T. Ericson (1987). Salivary flow rate and salivary glucose concentration in patients with diabetes Daneman D, Siminera L. (1985). The role of self-monitoring of blood glucose in the routine management of children with insulin dependent diabetes mellitus. Diabetes care 1985 ; 8 : pp. 1 -4. Eliaz Kaufman and Ira B. Lamster (2002). The diagnostic applications of saliva-A review. Crit rev Oral Biol Med; 13(12): pp. 197-212. http://www.mydr.com.au/tests-investigations/diabetes-and-urine-glucose-monitoring Huizinga M. M., Rothman R. L. (2006). Addressing the diabetes pandemic: A comprehensive approach. Indian J Med Res; 124: pp. 481-4. K. K. Mehrotra, T. N. Chawla, and A. Kumar (1968). Correlation of salivary sugar with blood sugar. Journal of the Indian Dental Association, 40(10): pp. 265–269. Mohan, S. Sandeep, R. Deepa, B. Shah and C. Varghese (2007). Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res 2007 ; 125 : pp. 217-230. NIH Publication: No:04-4551Oct:2003 http//diabetes.nidk.nih.gov/dm/pubs /glucosemonitor / index.htm Omar S., Khalil (1999). Sterioscopic and clinical aspects of non-invasive glucose measurements. Clinical chemistry 1999; 45 (2): pp. 165-177. P. Marchetti, M. Tognarelli, R. Giannarelli (1989). Decreased salivary glucose secretory rate: usefulness for detection of diabetic patients with autonomic neuropathy. Diabetes Research and Clinical Practice; 7(3): pp. 181–186. Pohl S. l., Gonder-Fredrick L. A. (1985). Self-measurement of blood glucose concentrations. Clinical significance of patient generated measurements. Diabetic Care 1985 ; 8 : pp. 617-9. Ralph A. De Fronzo (2004). Pathogenesis of type-2 diabetes mellitus. Med Clin N Am; 88 : pp. 787-835. Ramachandran A., Jali M. V., Mohan V., Snehalatha C., Viswanathan M. (1988). High prevalence Ramachandran A., Snehalatha C., Dharmaraj D., Viswanathan M. (1992). Prevalence of glucose intolerance in Asian Indians. Urban-rural difference and significance of upper bodyadiposity. Diabetes Care; 15: pp. 1348-55. Ramachandran A., Snehalatha C., Latha E., Vijay V., Viswanathan M. (1997). Rising prevalence of NIDDM in an urban population in India. Diabetologia 1997; 40 : pp. 232-7. S. Amer, M. Yousuf, P. Q. Siddqiui, and J. Alam (2001). Salivary glucose concentrations in patients with diabetes mellitus—a Journal of Biomedicine and Biotechnology minimally invasive technique for monitoring blood glucose levels. Pakistan Journal of Pharmaceutical Sciences, 2001; 14(1): pp. 33-37. Sicree R., Shaw J., Zimmet P. (2006). Diabetes and impaired glucose tolerance. In: Gan D, editor. Diabetes Atlas. International Diabetes Federation. 3rd ed. Belgium: International Diabetes Federation, pp. 15-103. Siliva Chiappin, Giorgia Antonelli, Rasalba Gatti, Elio F De Palo (2007). Saliva specimen : A new laboratory tool for diagnostic and basic investigation. Clinica Chimica Acto; 383 (1–2) : pp. 30-40. Sridhar G. R., Rao P. V., Ahuja M. M. S. (2002). Epidemiology of diabetes and its complications. In: RSSDI textbook of diabetes mellitus. Hyderabad: Research Society for the Study of Diabetes in India ; 2002 pp. 95-112. The diabetes control and complications trial research group. Lifetime benefits and costs of intensive therapy as practice in the diabetes control and complication trail. JAMA 1996; 276: 1409-15. Wild S., Roglic G., Green A., Sicree R., King H. (2004). Global prevalence of diabetes: Estimates for the year 2000and projections for 2030. Diabetes Care; 27: pp. 1047-53. William F. Ganong (1999). Review of Medical Physiology, 21st edn. Endocrine functions of the pancreas and regulation of carbohydrate metabolism: pp. 336-339.