|Year : 2020 | Volume
| Issue : 1 | Page : 54-59
Oral health-related quality of life in well-controlled diabetic patients of Modinagar city: A cross-sectional study
Monika Kumari1, Basavaraj Patthi1, Chandrashekar Janakiram2, Ashish Singla1, Ravneet Malhi1, Ananthalekshmy Rajeev1
1 Department of Public Health Dentistry, D. J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
2 Department of Public Health Dentistry, Amrita School of Dentistry, Kochi, Kerala, India
|Date of Submission||07-May-2019|
|Date of Decision||19-Aug-2019|
|Date of Acceptance||04-Dec-2019|
|Date of Web Publication||2-Mar-2020|
Dr. Monika Kumari
Department of Public Health Dentistry, D. J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Diabetes mellitus is a chronic metabolic disease, which is characterized by elevated levels of glucose in the blood. According to the International Diabetes Federation, around 366 million people are currently estimated to have diabetes. Aim: The aim of the study was to find out the association of oral health-related quality of life (OHRQoL) with diabetes among controlled diabetic patients of Modinagar city. Materials and Methods: This cross-sectional study with a sample of 163 respondents was conducted in a private hospital in Modinagar city, to assess the OHRQoL in a well-controlled diabetic patient. OHRQoL was estimated by the oral health impact profile-20 questionnaire. In addition, general health questionnaire (GHQ) – a 12-item questionnaire was included in this study to distinguish the impact of diabetes on general health of the patient. The analysis was performed using Statistical Package for the Social Sciences 21.0 (SPSS Inc., Chicago, IL, USA). Logistic regression was used to determine the association between OHRQoL and diabetes. Correlation between OHQoRL and GHQ was analyzed using Spearman's rho. P < 0.05 was considered statistically significant. Results: The study results showed that 93 patients (57.4%) had good and 69 patients (42.5%) had low OHRQoL. The study also found out a statistically significant association of OHRQoL with diabetes in case of age of the participants (2.375 [1.094–2.528], P = 0.029**), educational level (0.511 [0.268–0.974], P = 0.041**), and frequency of toothbrushing (0.446 [0.208–0.957], P = 0.038**), whereas its association with smoking status (0.527 [0.235–1.182]), duration of disease (0.757 [0.343–1.671]), and mouth dryness (0.692 [0.316–1.513]) was statistically nonsignificant. There was a highly significant correlation between the OHRQoL and general health of the participants (Spearman's rho [r (162) =0.996], whereP < 0.05). Conclusion: There is a good correlation between OHRQoL and general health among controlled diabetic patients. The association between diabetes and OHRQoL is confined only to some of the variables. The study findings emphasize the importance of oral health in maintaining the overall health of diabetic patients.
Keywords: Dentistry, oral health, quality of life
|How to cite this article:|
Kumari M, Patthi B, Janakiram C, Singla A, Malhi R, Rajeev A. Oral health-related quality of life in well-controlled diabetic patients of Modinagar city: A cross-sectional study. J Indian Assoc Public Health Dent 2020;18:54-9
|How to cite this URL:|
Kumari M, Patthi B, Janakiram C, Singla A, Malhi R, Rajeev A. Oral health-related quality of life in well-controlled diabetic patients of Modinagar city: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2020 Dec 4];18:54-9. Available from: https://www.jiaphd.org/text.asp?2020/18/1/54/279823
| Introduction|| |
“The preservation of health is easier than cure of the disease.”
Disease is a specific abnormal condition that negatively affects the structure or function of part or all of an organism and is not due to any external injury. They are often understood as medical conditions that are associated with specific signs and symptoms. Nowadays, several systemic disease gains the popularity in the worldwide population, and diabetes mellitus is one of them. Due to its increased incidence, the World Health Organization (WHO) declared diabetes mellitus as an epidemic disease that accounts for 4.6 million deaths annually worldwide. According to the International Diabetes Federation, around 366 million people are currently estimated to have diabetes, of which 80% live in low- and middle-income countries., In India, about 32 million individuals are diabetic which indicates its highest incidence worldwide. These numbers are predicted to increase to 80 million by 2030.
When the term “diabetes mellitus” is used, it identifies a chronic metabolic disease, which is characterized by elevated levels of glucose in the blood., It is also chronic endocrine disease that represents a disorder in the metabolism of glucose, carbohydrates, proteins, and lipids, which is categorized by the incapacity of the organ to resist or produce insulin. There are several medical and oral complications associated with this noncommunicable disease., Medical complications commonly include retinopathy, neuropathy, renal disease, peripheral vascular disease, and coronary heart disease, whereas oral complications reportedly include tooth loss, gingivitis, periodontitis, reduced salivary flow, increased saliva glucose, and oral soft tissue pathologies., Soft tissue pathologies, particularly lesions associated with delayed healing and Candida infections, have been observed more frequently in diabetic populations. As the correlation between diabetes and oral disorders, knowledge regarding oral health-related quality of life (OHRQoL) in diabetic patients is an important aspect., According to the WHO, “quality of life is defined as an individual's perceptions of their position in life in the context of the culture and value system where they live, and in relation to their goals, expectations, standards, and concerns.“, It has been seen that uncontrolled diabetes and insulin treatment have negative impacts on the quality of the patients. At the evaluation of oral cavity changes in diabetic patients, usually, the attention is paid to the type 1 diabetes which is usually found in younger adults. It happens when the immune system destroys cells in your pancreas called beta-cells that are responsible for making insulin., The deficiency of insulin in diabetes may lead to hyposalivation and elevated salivary glucose level, which may put diabetic patients at a high risk of developing caries. In type 2 diabetes mellitus, concerning the older people with different sickness – changes related to age, arteriosclerosis, etc., the settlement whether changes found within the oral cavity have a relationship with the diabetes or else with other morbid conditions is difficult.,,,
There are various studies that show the relationship between the diabetes mellitus and the oral health of the patient., In 1993, Löe 1 proposed that periodontal disease was the sixth complication of diabetes mellitus, whereas in 2008, Taylor et al. and Borgnakke identified periodontal disease as a possible risk factor for poor metabolic control in people with diabetes mellitus. Bharateesh et al. carried out a case–control study on a diabetic and nondiabetic subject to assess the prevalence of oral disease that affects diabetic patients; the results indicated that dental caries was more in nondiabetic group than in diabetic group. The relationship between diabetes and dental caries, particularly among adults, has received less attention so far despite the fact that both the diseases are associated with ingestion of carbohydrates., These studies showed that oral disorders may affect the quality of life, but the effect in diabetic patients is not well investigated. Diabetic patients' well-being and oral health-related complications might help in the management of the diabetes and help in improving their satisfaction with life.,, Therefore, the present study was designed to find out the association of OHRQoL with diabetes among controlled diabetic patients of Modinagar city. The objectives were to find out the association between the OHRQoL and sociodemographic variables among diabetic patients and to find out the correlation between OHRQoL and general health among diabetic patients of Modinagar city.
| Materials and Methods|| |
Study design and study setting
This was a cross-sectional study conducted during January and February 2019 to assess the OHRQoL in well-controlled diabetic patients in Modinagar city. The patients were selected based on convenience sampling. All the participants with the well-controlled diabetes (HbA1c <8) and those who were present at the day of the study were included. The selected participants from the community health center and private clinics of Modinagar city had confirmed the diagnosis and are under the frequent recall visit.
The ethical clearance for the study was obtained from the institution review board of the college (Ref no: DJD/IEC/2019/A048), and informed consent was taken from all the participants.
Sample size determination
A pilot study was conducted among 20 diabetic patients to estimate the sample size, and the prevalence was found to be 11% among the participants. The subjects in the pilot study were not included in the main study. The sample size was determined using the following formula:
n = Z αpq/e2.
Thus, the sample size was estimated to be 162.
A prevalidated questionnaire was used to collect the data from the participants. The general information of the participants including age, gender, educational level, type of diabetes, length of time diagnosed with diabetes, and smoking habit was recorded. Questions related to oral healthcare such as frequency of brushing, frequency of dental visits, and being referred to a dentist by their physician were answered by the participants. OHRQoL was estimated by the oral health impact profile (OHIP)-20 questionnaire, which is the shortest version of OHIP. The questionnaire consisted of 14 multiple-choice questions assessing oral health-related problems in seven theoretical areas, including functional limitation, pain, physiological discomfort, physical disability, psychological disability, social disability, and handicap. Based on the presence/absence of the problem and its severity, the answers were classified into five groups, and each answer took the score of 1–5 as: never (the problem was never experienced) =5, seldom = 4, occasionally = 3, most of the times = 2, and always (the problem always existed) =1. A total score of 100 indicated the absence of difficulty or problem, whereas lower scores suggested that the respondent experienced some degree of oral health-related problems. OHRQoL was categorized into two levels as low for scores of 20‒59 and good for 60‒100. In addition, general health questionnaire (GHQ), a 12-item another questionnaire, was included in this study to distinguish the impact of diabetes on general health of the patient. The questionnaire consisted of six-positive point (PP) and six-negative point (NP) items. PP items had responses “better than usual,” “same as usual,” “less than usual,” and “much less than usual.” Responses to NP items are “not at all,” “no more than usual,” “rather more than usual,” and “much more than usual.” Higher scores indicate a more severe condition.
The collected data were analyzed using Statistical Package for the Social Sciences version 21.0 (SPSS Inc., Chicago, IL, USA). Logistic regression analysis was used to determine the association between OHRQoL and diabetes. Correlation between OHRQoL and general health was analyzed using Spearman's rho (P < 0.05 was considered statistically significant).
| Results|| |
The present study consisted of 162 diabetic patients in which 76 (46.9%) were male and 86 (53.1%) were female. Most of the participants corresponding to 61 (37.7%) were above the age of 50 years, and 101 (62.3%) had diabetes for ≥10 years. Mouth dryness, one of the typical oral signs of diabetes, was present in 55 (33.96%) patients. Most of the participants (112, 69.16%) used toothbrush and toothpaste as the oral hygiene aids, and 57.4% of the participants brushed once daily, whereas the rest 42.6% brushed twice daily. The community periodontal index (CPI) scores showed that 32.09% had gingival bleeding after probing, 28.39% had presence of supra- or sub-gingival calculus, 38.29% had a pocket depth of 4–5 mm, and the rest 1.23% had a pocket depth above 6 mm or more. The frequencies of demographic variables assessed in the studied sample are given in [Table 1].
|Table 1: Sociodemographic data, dental history of participants, and CPI score|
Click here to view
With regard to satisfaction with life, the results indicated that 93 (57.4%) had good OHRQoL and 69 (42.6%) had low OHRQoL. According to the logistic regression analysis, age of the participant, educational level, and frequency of toothbrushing showed a significant association with the OHRQoL of the patient, whereas smoking status, type of diabetes, duration of disease, mouth dryness, etc., showed no significant association. The odds ratio for the age of participants was found to be 2.375 (1.094–5.154) and for educational status was 0.511 (0.268–0.974), which showed a significant association with diabetes mellitus. Frequency of toothbrushing showed a significant association with OHRQoL with odds ratio of 0.446 (0.208–0.957) [Table 2]. Frequency distribution of the subjects answered to each of the questions on GHQ is described in [Table 3]a and b. The mean value for OHRQoL in 162 participants was 45.46, with a standard deviation of 8.961. The mean value of PP of general health in the same participants was found to be 12.26 ± 4.245, and the mean value of NP was found to be 12.15 ± 4.802. This indicates a borderline health of the participants with controlled diabetes, and the disease symptoms may increase if the diabetes level increases. The study used Spearman's rho between the OHRQoL and general health of the participants and found out a highly significant correlation between both (r(162)= 0.996, P < 0.01).
|Table 2: The association between oral health-related quality of life and characteristics of diabetic patients|
Click here to view
| Discussion|| |
Diabetes mellitus is one of the most prevalent chronic diseases all around the world, which has profound effects on oral health. Hence, there is an increased evidence of diabetic-related oral complications, the present study analyzes the association of oral health status, OHRQoL, and general health in diabetes patients., Many researches have been done on the quality of life among diabetic patients, but few have evaluated their OHRQoL.
In our study, the evaluation of OHRQoL using a 20-item OHIP-20 questionnaire was found out that oral complications of diabetes have not adversely affected OHRQoL of these patients. These results are in agreement with the studies by Allen et al. and Sadeghi et al.
The study included more number of participants who were above the age of 50 years and 53.1% of the total participants being females. Almost similar results were found out in a study done by Sadeghi et al. in 2014 which revealed that 63.5% of the participants were above the age of 50 years while 56% of the total participants were females. Most of the participants in our study were literate (57.4%), and its association with OHRQoL was statistically significant. These results are in contrast with the study by Sadeghi et al. (70.5% were illiterate). A study by Bissong et al. found out that diabetic patients were more exposed to gingivitis, periodontitis, and oral candidiasis than nondiabetics. Similarly, our study found out a higher CPI score in almost all the participants, and the noticeable thing is that none of the participants had a healthy periodontium.
In our study, age of the participant, educational level, and frequency of toothbrushing showed a significant association with the OHRQoL of the patient, whereas the smoking status, type of diabetes, duration of disease, mouth dryness, etc., showed no significant association. In a study by Sadeghi et al., age, level of education, frequency of brushing, duration of diabetes, and being referred to a dentist by a physician had some effects on scores of OHRQoL, while type of diabetes, smoking, and frequency of dental visits had no significant effect on OHRQoL.
According to a review by Wändell, age, sex, ethnicity, socioeconomic factors, educational level, and income have been reported to have no specific effects on diabetic HRQL. While evaluating the correlation between OHRQoL and general health of participants, a highly significant association was found in our study. These results imply the importance of good oral health in maintaining general health of diabetic patients. Since the participants in the study were clinically examined and the CPI scores were recorded, the results can be considered relevant to a greater extent.
The overall evaluation of our study revealed that diabetes did not hamper the OHRQoL of patients to a larger extent; however, there might be a relationship between some variables and OHRQoL. At the same time, the significant correlation between OHRQoL and general health in our study needs more attention since it is a relevant topic in the field of both dentistry and general medicine.
| Conclusion|| |
There is a good correlation between oral health quality of life and general health among controlled diabetic patients. The association between diabetes and OHRQoL is confined only to some of the variables. Even though further researches have to be conducted to generalize the results, the study findings emphasizes the importance of oral health in maintaining the overall health of diabetic patients. Dentists and physicians play an important role in improving diabetic patient's knowledge, regarding oral complications and their effect on their quality of life.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Scully JL. What is a disease? Disease disability and their definitions. Europ Molecul Biol Org Rep 2004;5:650-3.
Gupta S, Sood S, Jain A, Garg V, Gupta J. Evaluation of oral health knowledge, attitude, and practices among diabetics in a northern union territory of India. Indian J Dent Sci 2017;9:148-52. [Full text]
Ship JA. Diabetes and oral health: An overview. J Am Dent Assoc 2003;134:4S-10.
International Diabetes Federation (IDF) Atlas; 2015. Available from: http://www.idf.org
. [Last accessed on 2019 Apr 02].
Kaur S, Kaur K, Rai S, Khajuria R. Oral health management considerations in patients with diabetes mellitus. Arch Med Health Sci 2015;3:72-9. [Full text]
Sadeghi R, Taleghani F, Farhadi S. Oral health related quality of life in diabetic patients. J Dent Res Dent Clin Dent Prospects 2014;8:230-4.
Paredes-Rodríguez VM, Torrijos-Gómez G, González-Serrano J, López-Pintor-Muñoz RM, López-Bermejo MÁ, Hernández-Vallejo G. Quality of life and oral health in elderly. J Clin Exp Dent 2016;8:e590-6.
Nikbin A, Bayani M, Jenabian N, Khafri S, Motallebnejad M. Oral health-related quality of life in diabetic patients: Comparison of the Persian version of geriatric oral health assessment index and oral health impact profile: A descriptive-analytic study. J Diabetes Metab Disord 2014;13:32.
Artur C, Otto-Buczkowska E. Oral health problems among diabetic patients part of dental professionals in diagnostic and therapy. J Oral Hygiene Health 2014;18:1-5.
Gupta V, Willis M, Johansen P, Nilsson A, Shah M, Mane A, et al
. Long-term clinical benefits of canagliflozin 100 mg versus sulfonylurea in patients with type 2 diabetes mellitus inadequately controlled with metformin in India. Value Health Reg Issues 2019;18:65-73.
Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997;25:284-90.
Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al
. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003;289:76-9.
Locker D, Allen PF. Developing short-form measures of oral health-related quality of life. J Public Health Dent 2002;62:13-20.
Locker D. Measuring oral health: A conceptual framework. Community Dent Health 1988;5:3-18.
Tervonen T, Oliver RC. Long-term control of diabetes mellitus and periodontitis. J Clin Periodontol 1993;20:431-5.
Lim SM, Siaw MY, Tsou KY, Kng KK, Lee JY. Risk factors and quality of life of patients with high diabetes-related distress in primary care: A cross-sectional, multicenter study. Qual Life Res 2019;28:491-501.
Bissong M, Azodo CC, Agbor MA, Nkuo-Akenji T, Fon PN. Oral health status of diabetes mellitus patients in Southwest Cameroon. Odontostomatol Trop 2015;38:49-57.
Bowyer V, Sutcliffe P, Ireland R, Lindenmeyer A, Gadsby R, Graveney M, et al
. Oral health awareness in adult patients with diabetes: A questionnaire study. Br Dent J 2011;211:E12.
Malvania EA, Sheth SA, Sharma AS, Mansuri S, Shaikh F, Sahani S. Dental caries prevalence among type II diabetic and nondiabetic adults attending a hospital. J Int Soc Prev Community Dent 2016;6:S232-6.
Arab H, Keshavarzi F. Correlation of oral health status and salivary antioxidant capacity in type 2 diabetes mellitus. Iranian J Diabetes Obesity 2018;10:11-8.
Mourão LC, Garcia E, Passos D, Lorena T, Canabarro A. Impact of well-controlled type 2 diabetes mellitus on quality of life of chronic periodontitis patients. J Indian Soc Periodontol 2016;20:623-6.
Cheah W, Lee P, Lim P, Fatin Nabila A, Luk K, Nur Iwana A. Perception of quality of life among people with diabetes. Malays Fam Physician 2012;7:21-30.
Coffey JT, Brandle M, Zhou H, Marriott D, Burke R, Tabaei BP, et al
. Valuing health-related quality of life in diabetes. Diabetes Care 2002;25:2238-43.
Taylor GW, Loesche WJ, Terpenning MS. Impact of oral diseases on systemic health in the elderly: Diabetes mellitus and aspiration pneumonia. J Public Health Dent 2000;60:313-20.
Bharateesh J, Ahmed M, Kokila G. Diabetes and oral health: A case-control study. Int J Prev Med 2012;3:806-9.
Gul A, Banjar M, Redwan M, Elkwatehy WM. Influence of diabetes mellitus on dental health status. Int J Health Sci Res 2017;7:125-9.
Akyuz S, Yarat A, Bayer H, Ipbuker A. Diabetic patient's knowledge level on oral health and habits (questionnaire). Oral Health Dent Manag Black Sea Countries 2004;3:11-4.
Lalla E, Papapanou PN. Diabetes mellitus and periodontitis: A tale of two common interrelated diseases. Nat Rev Endocrinol 2011;7:738-48.
Moosa Y, Shahzad M, Shaikh AA, Matloob SA, Khalid M. Influence of diabetes mellitus on oral health. Pak Oral Dent J 2018;38:67-70.
Mohsin SF, Fawwad A, Mustafa N, Shoaib A, Basit A. Impact of type 2 diabetes mellitus on oral health related quality of life among adults in Karachi, Pakistan-A cross-sectional study. J Advan Med Med Res 2017;1:1-7.
Gao W, Stark D, Bennett MI, Siegert RJ, Murray S, Higginson IJ. Using the 12-item General Health Questionnaire to screen psychological distress from survivorship to end-of-life care: Dimensionality and item quality. Psychooncology 2012;21:954-61.
Wändell PE. Quality of life of patients with diabetes mellitus. An overview of research in primary health care in the Nordic countries. Scand J Prim Health Care 2005;23:68-74.
[Table 1], [Table 2], [Table 3]