Diabetes is a leading cause of death all over the world. It has become an economical and social challenge, of grave concern to many countries. Last year, more than 25% of the State’s health budget was spent on diabetes and its complications. More than 50% of people with diabetes don’t know they have it. Although more and more awareness campaigns attempt to reduce that number, people are still reluctant to get tested for fear they might find out that they have this chronic disease.
The most common way to test for diabetes is pricking your finger and testing the blood drops on a glucometer. Another way involves complex tear testing. But what if there was another, quicker way of checking blood sugar levels?
A local research team is in the early stages of developing a new method for testing diabetes that involves checking for biomarker levels in saliva. To mark World Diabetes Day, we interviewed Professor Abdul Badi Abou Samra, Chairman of the Department of Medicine and Senior Consultant in Endocrinology and Diabetes, to find out more.
Previous studies conducted at Weill Cornell Medical College in Qatar show that saliva contains chemicals that can reflect the body’s glucose levels. In order to move this finding one step closer to clinical application, the research team from Hamad Medical Corporation collaborated with Weill Cornell Medical College in Qatar and its professors to further explore these studies.
One of the chemicals that can indicate blood sugar levels is called 1,5-anhydroglucitol, or short 15AG, which, according to Prof. Abou Samra, has the same composition similar to sugar itself and also to another molecule called galactose.
What is 15AG?
15AG enters the body through nutrition and then is eliminated. According to Professor of Physiology and Biophysics and Director of Bioinformatics Core at Weill Cornell Medical College in Qatar, Dr. Karsten Suhre, “As a diabetic your kidneys are overloaded with sugar, since there’s too much sugar in the blood, in this situation the kidney will eliminate the 15AG molecule faster as it tries to keep the sugar in the body. The result of this faster loss of 15AG is a measure of the average glucose levels of the patient over a week’s time or so, so that the patient’s blood levels for the week can be monitored that way.”
This process is known to occur in blood. However, what was new in their research was that chemicals in saliva actually mirror those in the bloodstream. “When you look at the saliva levels and the blood levels of sugar, for 15AG they mirror each other, showing you away to measure it in a non-invasive way without the need to draw blood” said Prof. Abou Samra.
The molecule 15AG remains in the body for about 21 days. According to Prof. Abou Samra, the body is unable to use the molecule or metabolize it. The higher the glucose in the blood, the lower the levels of 15AG.
15AG is not only used to test for diabetes or sugar levels. Researchers and students are also using this molecule to predict cardiovascular diseases.
Tests and Research
The initial study started in 2012, together with a study conducted the Dermatology Department under Dr. Mohammed M. El-Din Selim. A total of 400 voluntary participants took part, both diabetic and non-diabetic, from different ethnicities, mainly Arabs, Indians, and Filipinos from all age groups.
According to the research team, some of the results were unclear due to the presence of an additional molecule that destroys and overshadows 15AG’s signal. In their first challenge the team found a negative coloration between the blood and saliva tests, however, they now know they needed to eliminate the additional molecule to be able to measure sugar levels in saliva.
Many devices and research tools are needed to carry out this test. “We want to bring this test to the public, but we are not there yet,” said Prof. Abou Samra. However, the researchers are using chemical analyzers to measure other important chemicals. “These chemical analyzers are fairly inexpensive and can show the development of the method of testing if we find a way to get rid of the overshadowing chemical,” added Dr. Suhre. “A system developed in Japan and the U.S. called 15AG glycomark can also be useful in testing saliva after certain chemicals are eliminated.”
Approvals and Standards
Qatar uses American-European standards in the medical field. “To get the saliva test to the public requires first to get rid of the galactose and then to measure the 15AG. Once that is published and approved by the authorities, then we can implement the test, develop it and sell it internationally,” said Professor Abou Samra.
Many diabetes tests have taken a long time to develop, like the finger prick test, which was only developed recently. Prior to that, blood samples were taken to labs for testing, as well as hemoglobin A1C. “We think we can do the same with the saliva test,” said Prof. Abou Samra.
What are the Benefits of Saliva Testing?
The saliva test will be a portable device, easy to carry to the malls or events. Unlike blood tests, it will not be messy, and will not require the patient to be fasting, which will lead to more people testing their sugar levels this way. Just a swipe of your saliva and you’re ready to go.
The research team aims to get more partners and researchers interested in helping to develop this test and collaborate with organizations that will provide some insight or techniques to eliminate the chemicals overshadowing 15AG. The research is being funded in great part by the State. However, to create a final product, more partners and collaborators must pitch in.
Dr. Suhre added that there are misconceptions about the value of patented research and that if possible they will try their best to patent some aspect of the research to bring more attention and collaboration to this important issue.
The research is still ongoing. Could 2017 bring a new, easy diabetes test?
“I am very happy that we collaborated Cornell Medical Collage and Qatar Foundation, with Hamad Medical Corporation and Professor Abou Samra, because if we did not, we would not have gotten to this stage. I think we’ve created strong collaborative work. It all depends on the interest in the test, and how much time, effort, and money goes into this that makes it all worth it.” – Professor Karsten Suhre.