RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE- II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / NAME OF THE CANDIDATE
AND ADDRESS (in block letters) /

DR.SHOBHA NAIK

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 STUDY AND SUBJECT / MASTER OF DENTAL SURGERY, DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY
4 / DATE OF ADMISSION TO COURSE / MAY 2010
5 / TITLE OF THE TOPIC / EVALUATION & COMPARISON OF TASTE PERCEPTION AMONG DIABETES MELLITUS TYPE 2 PATIENTS & HEALTHY CONTROLS
6
6.1
7 / BRIEF RESUME OF INTENDED WORK
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 .
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: 768-70
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
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11.1
11.2
11.3
11.4 / Name & Designation of
Guide
Signature
Head of Department
Signature /
Dr. Sujatha.D
Professor
Dept Of Oral Medicine and Radiology
Dr. K.S .Ganapathy
Professor and HOD
Dept Of Oral Medicine and Radiology
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12.1 / Remarks of the Chairman & Principal
Signature / Dr. K.S. Ganapathy
Professor and HOD
Dept Of Oral Medicine and Radiology