Candida in patients with diabetes mellitus type II on insulin with metformin vs. metformin only : randomized clinical trial

الملخص EN

Introduction: Candida albicans can cause multiple illnesses affecting the oral mucosa, especially in immunocompromised patients.

Diabetes mellitus type II may reduce immunity.

Wearing dentures will violate the normal flora by harbouring more plaque Objectives: The aim of present study was to investigate the prevalence of C.

albicans in the oral cavity among type II diabetic patients on insulin with metformin vs.

those on metformin only with or without an acrylic plate.

The effect of the level of oral hygiene on candida growth was also assessed.

Methods :The study was carried out on 100 (50 male, 50 female) patients who had been diagnosed with type II diabetes mellitus at least 1 year previously.

An upper acrylic plate was constructed for Test group which allocated of 50% of the sample (25% male, 25% female), consisting of an acrylic plate covering the upper denture, clasps and Adams clasps for molars and premolars.

We asked the patients to wear the plate full time and gave them instructions on how to clean it regularly, and to remove it at night.

The glycohaemoglobin (HbA1c, A1C) test was performed on all patients at beginning of study.

Samples were collected from the hard palate of dentate patients and from the tissue-bearing area of the upper denture by scraping with a sterile swab.

The swabs were processed for microbiological examination by immersion in 5 ml of sterile 0.9% physiological saline.

This was vortexed for 1 minute to disperse the adhering bacteria.

A loopful of the suspension was plated on Sabouraud’s dextrose (SD) agar containing gentamycin (2 mg/dL) and chloramphenicol (5 mg/dL) and incubated for 48 h at 37°C.

Results: The sample consisted of 100 (50 male, 50 female) participants aged 20–68 years (mean, 49.1 ± 10.7 years; men, 47.5 ± 8.4 years; women, 50.6 ± 8.8 years).

C.

albicans was isolated from 32 (32%) patients.

The mean HbA1c level was 8.27% ± 1.41 in those positive for Candida and 8.38% ± 1.58 in those negative for Candida.

Patients on metformin only had a mean HbA1c of 8.33% ± 1.02 and those on insulin with metformin had a mean HbA1c of 8.28% ± 1.80.

In the control group the mean HbA1c was 8.42% ± 1.47 and in the test group with the acrylic plate it was 8.19% ± 1.45.

The prevalence of C.

albicans was higher in patients on metformin only than in patients on insulin with metformin.

The prevalence of C.

albicans was higher in the test group with the acrylic plate than in the control group without the acrylic plate.

Poor oral hygiene had an influence directly on the prevalence of C.

albicans in both groups.

Males had poorer oral hygiene than females.

Conclusion: Treatment Protocol for Treating Diabetes type II using Insulin with Metformin or Metformin only and the use of an acrylic plate had no effect on increasing or decreasing the candida albicans prevalence.

On the other hand the level of oral hygiene had more influence on the prevalence of C.

albicans, with males being more susceptible than females.

HbA1c test cannot be used as an indication JOURNAL OF THE ROYAL MEDICAL SERVICES 55 Vol.28 No.1 April 2021 of the possibility of colonization by C.

albicans among type II diabetic patients, because the level of control of glucose found in current study to be not the major factor.

Oral Hygiene level proofed to be important factor affecting the Candida albicans growth .future investigation recommended for other diabetic medications and effect of glucose level in saliva on prevalence of oral candida albicans.