Association between diabetes mellitus and pre-malignant oral diseases: A cross sectional study in Kerala, India

Abstract

Recent studies have suggested role of diabetes mellitus in the development of periodontal diseases, oral inflammatory and neoplastic lesions. We analysed data from randomised oral cancer screening trial in Kerala, India, to study the association between chronic diseases in general, diabetes mellitus in particular, and pre-malignant oral lesions and conditions. A total of 927 subjects with oral leukoplakia, 170 with oral submucous fibrosis, 100 with erythroplakia lesions and 47,773 apparently healthy subjects constituted the cases and controls respectively for our present study. The odds ratio (OR) for oral leukoplakia among women with a history of diabetes mellitus was found to be 2.0 (95% confidence interval (CI) 5 1.4-2.9) whereas that for erythroplakia was 3.2 (95% CI 5 1.3-7.9), after adjusting for potential confounders. No statistically significant association between diabetes mellitus and oral submucous fibrosis and pre-cancerous lesions/conditions in men was found. An association between diabetes mellitus and premalignant oral lesions among women has been observed in our study, although the underlying mechanisms are not clear. This needs to be further evaluated in other settings. ' 2005 Wiley-Liss, Inc.Key words: pre-malignant oral conditions; diabetes mellitus; chronic diseases Betel quid chewing with or without tobacco, smoking and alcohol drinking are well-established risk factors for pre-malignant oral diseases.1 Recently attempts have also been made to investigate an association between clinical variables and risk of premalignant oral diseases. Past history of diabetes has been linked with development of pre-malignant oral diseases in a few studies.2,3 An association between diabetes mellitus and periodontal and oral diseases, and various inflammatory lesions in oral cavity has also been demonstrated. 4 An association between diabetes mellitus and cancers of the colon, 5 endometrium, 6 kidney, 7 pancreas 8 and stomach 9 has been reported in recent literature. Our study addresses the association between chronic diseases, including diabetes mellitus and oral leukoplakia, erythroplakia and submucous fibrosis.Our present study is based on the data collected from the first round of intervention from a randomised oral cancer screening trial in Kerala, India. 10 We have reported previously the role of chewing betel quid with and without tobacco, alcohol, body mass index (BMI) and socio-economic status in development of premalignant oral lesions using the same data set. [11][12][13][14][15] We considered a total of 927 leukoplakia, 100 erythroplakia and 170 submucous fibrosis cases and 47,773 controls to assess the role of various chronic diseases, diabetes mellitus in particular, in the development of pre-malignant oral lesions. To our knowledge, this is the first large study on this topic. Material and methodsA cluster randomised, controlled oral cancer screening trial was conducted in the Trivandrum district, India, to evaluate the efficacy of screening in reducing oral cancer mortality. Details of study...

Correlation of Lipid Profile and Glycemia in Oral Precancerous Lesion and Conditions

“…Chalkoo A.H et al 10 found increase in serum HDL-C level in oral submucous fibrosis patients which was not consistent with the results of present study. Mehrotra Ret al 16 found a significant increase in serum VLDL level in oral pracanerous group when compared with control group which was inconsistent with the results obtained in the present study.The result of present study showed that Fasting and Post Prandial blood sugar level didn't alter in oral submucous fibrosis and leukoplakia group when compared with the control group which was consistent with the results obtained by Dikshit RP et al 4 andSaini R et al 24 Meisel Pet al 25 and Albrecht M et al 26 found that the prevalence of leukoplakia in diabetes is significantly high which was inconsistent with the results of present study. The possibility of having variation in serum lipid profile of precancer group when compared with the control group can be explained by the following reasons.…”

“…3 In few epidemiological studies increased prevalence of oral premalignant lesions in Diabetic Patients has been reported. 3,4 Researchers have reported that there is an association between dyslipidemia with different cancers as neoplastic disease is related to new growth, there is greater utilization of lipids for new membrane biogenesis. Cells fulfill these requirements either from Hence present study was carried out to evaluate alteration in serum lipid profile and glycemia in 30 oral submucous fibrosis patients and 30 oral leukoplakia patients and was compared with 30 control groups.…”

Oral leukoplakia manifests differently in smokers and non-smokers

“…10 It is difficult to establish an at-risk age for OL development, mainly due to the multiple independent factors that are associated with age and OL, such as chewing betel quid 10,15 and whether the patient has type 2 diabetes. 16,17 In our sample, patients 61 years old and above were mainly non-smoking women. As stated above, factors other than smoking may be associated with OL in this group of patients with more advanced age.…”

Impaired Glucose Tolerance and its Association to Oral Cancer

“…Recent studies say that insulin promotes the synthesis and biological activity of insulin like growth factors 1(IGF1) which act as a growth factor that promote cell proliferation and inhibits apoptosis. There is evidence that the effect of IGF-1 might be related to p53 mutations, which are quite common in head and neck malignancies [9,10]. Several prospective populationbased studies have assessed the association between diabetes and cancer death, but laboratory parameters used were fasting plasma glucose levels [11,12] or post prandal glucose levels [13,14].…”