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Original Article

Assessment and Evaluation of Gustatory Functions in Patients

with Diabetes Mellitus Type II: A study
Shriya Khera, Anjali Saigal1
Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, 1Oral Medicine and Radiology, Thapar Hospital and Research
Institute, Moga, Punjab, India

Abstract
Introduction: The assessment of taste is critically important for an individual to enjoy life. This however, gets altered in various diseases.
Diabetes Mellitus is one of the diseases in which person has dysgeusia. Objectives: This study was done to assess different taste sensations in
patients suffering from Diabetes Mellitus Type II. Methods: A total of 120 subjects were taken in this study and were divided into 3 groups.
One group consisted of patients who were uncontrolled diabetics (n = 40), the second group of controlled diabetics (n = 40) and 40 subjects
who were normal healthy individuals (control group). To assess their gustatory functions, two tests were performed, whole mouth above
threshold and localized taste test. Whole mouth above threshold test was performed by assessing their detection threshold for each taste.
Results: It was seen that patients with Diabetes Mellitus showed a high threshold to sweet, salty and sour taste. Bitter was not affected in
either of the groups. The other test performed was localized (spatial) test. In this test, various parts of the oral cavity are assessed by dabbing
the highest concentration of the prepared solutions and their response is noted. The tongue was divided into Left posterior tongue (LPT), Right
posterior tongue (RPT), Right Anterior tongue (RAT), Left Anterior tongue (LAT). Soft palate was divided into Right Soft Palate (RSP) and
Left Soft Palate (LSP). The results showed a significant difference for the sweet taste in the localized regions (right anterior tongue [RAT],
left anterior tongue [LAT], right posterior tongue [RPT], left posterior tongue [LPT], right soft palate [RSP], and left soft palate [LSP]) of
the mouth between the three groups (P < 0.05). The results of the salty taste showed significant differences in the RAT, LAT, RSP, and LSP
regions of the mouth between the groups (P < 0.05). However, the regions of LPT and RPT showed no differences between the study groups
(P > 0.05).The results showed a significant difference in the sour taste in the localized regions of the mouth in all the study groups (P < 0.05).
The results of the bitter taste showed significant differences in the regions of the mouth in all the three groups (P < 0.05). However, the region
of LPT showed no differences between the study groups (P > 0.05). Conclusion: Within the limitation of this study, it was concluded that the
diabetic patients had an increased satiation effect of sweet taste therefore they needed an increased quantity of sweet taste to be perceived.
It was also significant for salty and sour taste, whereas bitter taste had no significance. Spatial taste test also showed differences in different
regions of the tongue, soft palate. The left posterior tongue area showed no changes.

Keywords: Detection threshold, dysgeusia, gustatory function, Diabetes mellitus, spatial

Introduction to quench their thirst is seen. Dysgeusia is also commonly

seen in DM Type 1 and Type 2 patients with a significant and
Human taste perception may be categorized into four well known
somewhat specific impairment in sweet taste detection.[4,5]
and widely accepted descriptors, namely sweet, bitter, salty, and
Chemical gustometric score (CGS) has been frequently used
sour.[1,2] Taste disorders have been reported during the course of
to screen diabetic patients for taste disorders and is usually
various diseases. Diabetic patients appear to be especially prone
based on a threshold for each of the four primary tastes. CGS
to taste disorders; these disorders have been described during the
is a global evaluation of taste based on all four primary tastes.
course of diabetes mellitus (DM). The common observation of
this disorder is chronic hyperglycemia, resulting from either a
defect in insulin secretion from the pancreas or resistance from Address for correspondence: Dr. Anjali Saigal,
Thapar Hospital and Research Institute, Moga, Punjab, India.
the body’s cells to insulin action or both.[3] In newly diagnosed E‑mail: [email protected]
untreated diabetic patients, their preference for sweet drinks
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DOI: How to cite this article: Khera S, Saigal A. Assessment and evaluation
10.4103/ijem.IJEM_555_17 of gustatory functions in patients with diabetes mellitus Type II: A study.
Indian J Endocr Metab 2018;22:204-7.

204 © 2018 Indian Journal of Endocrinology and Metabolism | Published by Wolters Kluwer - Medknow
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Khera and Saigal: Gustatory function appreciation in diabetes mellitus Type II

The present study was planned to evaluate the gustatory water was given to remove the residual taste. Then, he was
function appreciation in patients with DM Type  II and to asked to identify correctly the quality of the taste  (namely,
compare the intensities among four basic tastes in these sweet, salty, sour, bitter, and tasteless) and it was recorded. If
patients. A  regional taste examination was also carried out the participant failed to identify the correct solution, a solution
to evaluate the gustatory function in six different locations with a next higher concentration was presented. Once an
of the oral cavity in the same patients and correlations and accurate selection was made, the procedure was repeated at the
comparisons among them, along with considerations to age same concentration until three consecutive correct responses
and gender of the participants who participated in the study. were obtained and it was the recorded as detection threshold
and was scored. The scores were given as “1” for the lowest
The aim and objective of this study was to assess the gustatory
concentration and “5” for the highest concentration.
function in patients with DM, to compare their results with
normal healthy individuals. This was done by performing Spatial (localized) taste test
whole‑mouth test and spatial (localized) taste test. In this test, the ability of the participants to identify different
tastes in various localized areas of the mouth was evaluated.
Materials and Methods The six different locations were right and left anterior and
posterior lateral surface of tongue and the two sides of soft
The present study was conducted in the Department of Oral palate, lateral to the midline. This test consisted of applying
Medicine and Radiology, Dasmesh Institute of Research and each taste stimulus of highest concentration and distilled
Dental Sciences, Faridkot (Punjab), on 120 participants after water (blank) in these areas for 5 s. It was ensured that the areas
the ethical clearance was obtained. The age range of these of application of the tastant and distilled water were at least
participants was from 24 to 73 years. These 120 participants 2 cm away from each other. The response of the participant
were divided into two groups, Group A having individual with was given a score on the intensity scale ranging from 0 for no
DM Type  II and Group  B who were nondiabetics  (normal taste to 9 for very strong taste.
healthy individuals). Group A was further divided into two
categories: controlled diabetics and uncontrolled diabetics
based on the HbA1c values. It was made sure that the patients Results
did not have any neuropathies and the patients had normal For all 120 patients, age range was from 24 to 73 years with
salivary gland functioning. No patients having any other a mean of 46.31 (±10.957 standard deviation [SD]) years. In
medical illness except for DM were included in the study. all the three groups, there were 60 males and 60 females. The
values of hemoglobin % ranged from 9.0 to 14.8 gm% with a
The various taste solutions were prepared to assess the whole mean of 12.617 (±1.35 SD). The random blood glucose levels
mouth threshold with varying concentrations to grade the showed a gradual decrease in the random blood glucose values
intensity. The various concentrations for sweet taste made from from Group I to Group III. The glycosylated hemoglobin values
sucrose were (0.01-1.00 mol/L), NaCl for salty taste (0.01-1.00 showed a decrease in the values of HbA1c from Group I to
mol/L), citric acid for sour taste (0.032-0.320 mol/L), quinine Group III.
hydrochloride for bitter taste (0.01-1.00 mol/L). Blood tests
were performed including hemoglobin, random blood sugar The results of the whole‑mouth, above‑threshold taste test of
level, Glycated hemoglobin (HbA1c).  Hence, three groups the sweet taste suggested that there is a trend toward decreased
were formed of total 120  patients: Group  I consisted of sensitivity for sweet taste from Group  III to Group  II to
uncontrolled diabetics  (HbA1c  >7%), Group  II consisted Group  I  (P  <  0.01). For the sweet taste, 16 participants in
of controlled diabetics (HbA1c – up to 7%), and Group III Group I and one participant in Group II showed hypogeusia,
consisted of normal healthy individuals (HbA1c <5.6%). whereas no participant with hypogeusia was seen in Group III.
The salty taste was assessed and it was seen that the mean value
Procedure for gustatory function evaluation was the highest in Group III followed by Group II and lowest
For testing gustatory functions, two different tests were in Group I which showed gradual decrease in the sensitivity
administered: a whole‑mouth, above‑threshold test and of the taste buds to salty taste  (P  <  0.01). For salty taste,
spatial (localized) taste test. seven participants had hypogeusia in Group I and none of the
Whole‑mouth, above‑threshold test participants in the other two groups showed hypogeusia. The
The patient was asked to rinse the mouth thoroughly with score for the sour taste was highest in Group III as compared to
distilled water, followed by presenting with three rows of Group II and least in Group I which shows a gradual decrease
in the sensitivity of the taste buds to sour taste (P < 0.01). In
cups which were randomly arranged on a tray. One of the cup
Group  I, six participants showed hypogeusia to sour taste
contained 5 ml of the sample solution while the remaining
whereas no participant showed hypogeusia in Group II and
two had 5 ml of distilled water. The subjects were given one
III. There was no significant difference for the bitter taste in
cup of 5 ml solution at a time and were asked to sip, swish for
all the three groups (P > 0.05).
15 seconds and spit out the sample. If the patient was unable
to identify, a higher concentration was given and the same The localized taste test was done to assess the intensity
procedure was done. In between of presenting the samples, of each tastant, and it was rated on an intensity scale. The

Indian Journal of Endocrinology and Metabolism  ¦  Volume 22  ¦  Issue 2  ¦  March-April 2018 205
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Khera and Saigal: Gustatory function appreciation in diabetes mellitus Type II

results showed a significant difference for the sweet taste areas of the tongue.[13] In the present study, we also evaluated
in the localized regions (right anterior temporal [RAT], left sensitivity to localized areas of the mouth. The three groups
anterior temporal  [LAT], right posterior tongue  [RPT], left showed significant changes in the values of intensity to sweet
posterior tongue [LPT], right soft palate [RSP], and left soft taste in the RAT, RPT, LAT, LPT, RSP, and LSP (P < 0.05). The
palate [LSP]) of the mouth between the three groups (P < 0.05). response to salty taste in the localized regions of the mouth also
The results of the salty taste showed significant differences in showed significant values (P < 0.05) except for the regions in
the RAT, LAT, RSP, and LSP regions of the mouth between RPT and LPT (P > 0.05). The scores of the sour taste showed
the groups (P < 0.05). However, the regions of LPT and RPT significant results in all the three groups  (P  <  0.05). The
showed no differences between the study groups (P > 0.05). response of bitter taste in the localized areas was significantly
The results showed a significant difference in the sour altered between the three groups  (P  <  0.05) except for the
taste in the localized regions of the mouth in all the study response in the LPT. Gondivkar et al.  (2009)  concluded
groups  (P  <  0.05). The results of the bitter taste showed that all the tastes in the different regions of the mouth were
significant differences in the regions of the mouth in all the significantly altered except for the salty taste in the RPT and
three groups (P < 0.05). However, the region of LPT showed LPT area.
no differences between the study groups (P > 0.05).
Results of the present study showed that there was an
impairment of sweet, salty, and sour taste between the diabetic
Discussion participants when compared with normal healthy individuals in
CGS has been frequently used to screen diabetic patients whole‑mouth, above‑threshold test. The localized test showed
for taste disorders.[6] In the present study, Group  I showed that all the tastes, except for salty in the area of RPT and LPT
decreased detection threshold for sweet, salty, and sour and bitter in the area of LPT, showed significant differences.
taste. In Group  II, the participants responded to the lower Dental practitioners are often the first clinicians to be presented
concentrations of the taste solutions (sweet, salty, and sour) with complaints about changes in taste.[14] Considering the
when concentrations to Group I and Group III, the participants scanty literature and contradictory results on comprehensive
responded to lowest concentrations of the taste solutions which study of altered gustatory functions in patients with DM,
implies that was perceived in lower concentrations in all the this study was an attempt in the direction to provide useful
three groups. A study conducted by Gondivkar et al.[7] showed information to the dental clinician.
results which were in agreement to our study. Khobragade
et al.[8] observed that all the four tastes were affected in patients The response to whole mouth, above threshold taste test
with DM Type I as compared to normal healthy individuals. showed that the response to sweet, salty and sour taste was
Shanaz Mohammad and Raz[9] claimed that only sweet and attained at higher concentrations in Group I than Group II
salty taste got affected in patients with DM Type II as compared and least in Group III.The response to bitter taste in all the
to normal healthy individuals. Lawson et al.[10] concluded in individuals were achieved at lower concentrations in all the
their study that only sweet gets affected in patients with DM three groups showing that it does not alter in diabetic patients.
Type II. Sixteen participants from Group I and one participant Hypogeusia was seen in 16 subjects in Group I (Uncontrolled
from Group II had hypogeusia to sweet taste. No such results diabetics) and 1 subject in Group II (Controlled diabetics) to
were seen in Group III. Hypogeusia to salty taste was seen in sweet taste. Hypogeusia to salty taste was seen in 7 subjects
seven participants from Group I; none showed such response of Group I whereas none in any other groups showed these
from Group II and III. As regards to sour taste, six participants results. Hypogeusia to sour and bitter taste was not seen in
showed hypogeusia in Group I and no such response was seen any of the groups. Localized taste test was done to assess
in Group II and III. No hypogeusia to bitter taste was seen in the specific areas in response to taste. The results showed
any groups, and no subject showed ageusia. significant changes in the different areas of the tongue (RAT,
RPT, LAT, LPT) and soft palate (RSP, LSP) for sweet and
This result is contrary to the study conducted by Shailesh and sour taste. No significant changes were seen in the RPT and
Amol (2004)[11] in which six participants showed ageusia to LPT areas for salty taste and LPT for bitter taste were seen
sweet taste. The reason for this difference could be that in whereas other regions showed significant alterations.
our study, participants with only DM Type II were taken who
were not on any other medications, suggesting that diabetes Financial support and sponsorship
alone may not be possible for causing ageusia. Schelling et al. Nil.
suggested that taste alterations in diabetics result from sensory
Conflicts of interest
neuropathy or a nonspecific “satiation effect” due to persistently
There are no conflicts of interest.
elevated blood sugar concentrations. Because of decreased taste
sensitivity to glucose, it could result in an increased amount of
sugar to be ingested to produce a desired effect.[12] References
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