1. Association between glycemic status and oral Candida carriage in patients with prediabetes Dr. Fawad Javed BDS, PhD Eastman Institute for Oral Health University of Rochester, NY14620 Email: fawjav@gmail.com

2. Background Immunosuppression influences oral Candida carriage. High prevalence of Candida species in the oral mucosa and periodontal pockets among DM patients with CP than healthy controls. Previous studies were performed in patients with poorly-controlled DM.

3. Xerostomia and chronic hyperglycemia Xerostomia is common in patients with chronic hyperglycemia. An increased oral Candida carriage is associated with reduced SFR in diabetic patients. Oral Candida carriage in prediabetic patients is not yet investigated.

4. Prediabetes A)Impaired fasting glucose 100 to 125 mg/dL B)HbA1c levels between 5.5% and 6.4% are categorized as prediabetic individuals. Olson DE, et al. Screening for diabetes and pre-diabetes with proposed A1C-based diagnostic criteria. Diabetes Care. 2010;33:2184-2189. American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care. 2011;34 Suppl 1:S11-61.

5. Glycemic control and Oral Candida carriage Hammad et al. (2013): Subgingival Candida carriage is significantly lower in patients with well-controlled T2DM. (Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(3):321-6). Oral Surg Oral Med Oral Pathol Oral Radiol. Belazi et al. (2005): Parameters such as xerostomia, dentures, age, gender and glycemic control cannot be directly associated with Candida growth in the oral cavity (Mycoses. 2005;48(3):192-6).Mycoses.

6. Hypothesis Oral Candida carriage is high in prediabetic patients compared to healthy controls. Glycemic control does not affect oral Candida carriage in patients with a previous diagnosis of prediabetes

7. Title

8. Aim To assess the association between glycemic status and oral Candida carriage in patients with prediabetes

10. Ethical guidelines Ethical approval Consent form It was mandatory for all study participants to have read and signed the consent form before being included in this study.

11. Recruitment of participants Prediabetic patients were recruited from the diabetes care unit of a local hospital in Karachi, Pakistan Controls were recruited from a local residential area situated in the vicinity of the local hospital

12. Eligibility criteria Individuals with medically diagnosed prediabetes (FBGL: 100-125 mg/dL and HbA1c: 5.7%-6.4%) (a) tobacco smokers (b) alcohol consumption (c) Smokeless tobacco usage; (d) use of antibiotics, anti-fungal agents, steroids and/or NSAIDS within the past 3-months; (e) self-reported systemic diseases including T1DM, T2DM, Hepatitis B and C, HIV/AIDS

13. Parameters Demographic information Fasting blood glucose levels Hemoglobin A1c Unstimulated whole saliva Oral yeast samples from dorsum of tongue

14. Questionnaire Age Gender Duration of prediabetes Recommended treatment for prediabetes Oral hygiene maintenance –tooth brushing –tongue brushing –Use of oral rinses (mouthwashes)

15. HbA1c and FBGL levels Hospital records of prediabetic patients were searched to determine the most recent HbA1c levels. FBGL were measured using a glucometer

16. Subgroups in patients with prediabetes Based on HbA1c and FBGL: –Group A: FBGL between 100 and 125 mg/dL (HbA1c ≥ 5.5%) –Group-B: FBGL< 100 mg/dL (HbA1c < 5%)

17. Unstimulated whole saliva Patients were seated comfortably on a chair Requested to spit for 5 continuous minutes into a measuring cylinder (without swallowing) Salivary flow rate was determined

18. Collection of oral yeast samples Scraping the dorsum of the tongue and bilateral buccal mucosa with a sterile cotton swab. Reference: Javed et al. BMC Oral Health. 2009;9:12.

19. Identification of oral yeasts Polymerase chain reaction

20. Clinical oral examination Clinical assessment of lesions on the tongue and/or buccal mucosa –Fissured tongue –Coated tongue –Median rhomboid glossitis Missing teeth (excluding third molars)

21. Statistical analysis Performed using SPSS Version 18., Chicago, IL. USA. Level of significance between Groups A, B and C was assessed using Mann Whitney U-test. A multiple logistic regression model was applied to adjust for confounding variables (age, gender, numbers of MT, oral hygiene measures, UWSFR and culture/PCR results). P<0.05 were considered statistically significant.

23. Participants 80 patients with prediabetes –Subgroups in patients diagnosed with prediabetes : Group A: 43 patients Group B: 37 patients 70 controls

24. Questionnaire Tooth-brushing (Once daily) –Group A: 86% –Group B: 83.7% –Group C: 84.3% Tongue-brushing –None in all groups

27. Oral and tongue lesions Not clinically detected in any group

29. Oral Candida carriage is high in prediabetic patients than controls and is independent of glycemic status.

30. Thank You !