The masticatory efficiency or chewing ability is significantly decreased in patients with type 2 diabetes with diabetic neuropathy, suggests a recent cross-sectional study published in the journal PLos One.¹

Hamamoto et al sought to investigate the association between the chewing efficiency of patients with type 2 diabetes and microvascular complications in 172 patients with type 2 diabetes. The enrolled participants were hospitalized to be educated about diabetes, including diet and treatment from April 2016 to March 2020. More than half of the study population were men and the mean age of the participants was 61 years. Their average duration of diabetes was 11 years and the mean A1c was 10.3%. The chewing ability was measured with GLUCO SENSOR GS-Ⅱ, a masticatory ability testing system. The participants were comprehensively evaluated for diabetic nephropathy, neuropathy and retinopathy and they also underwent a dental check-up to detect loose or missing teeth or periodontitis.

Twenty-five percent of the participants had diabetic retinopathy, while 75% had diabetic retinopathy. More than half (53%) had mild chronic kidney disease (stage 1), while 34% had stage 2 CKD. About 13% had stage 3 and 4 CKD, while none had stage 5 or end stage kidney disease. None of the participants had dental implants, while 46 used dentures. The study subjects had, on average, 23 teeth and two moving teeth.

A significant link was noted between masticatory efficiency and duration of diabetes, number of remaining teeth (less than 20), number of moving teeth and presence of diabetic neuropathy. On multivariate analysis, this significant association was found to persist in patients with diabetic neuropathy and those who had less than 20 teeth. However, the chewing ability was not linked with diabetic retinopathy or diabetic nephropathy, which the authors say was “unexpected”. Periodontitis was also not associated with chewing ability.

Nutritional therapy constitutes an essential component of management of diabetes, not just as an adjunct to antidiabetic treatment, but also in educating the patient. Evidence indicates that people who eat fast increase their risk of developing diabetes suggesting eating speed as a modifiable risk factor.² Chewing well or eating slowly is associated with greater weight loss. Patients with diabetes should also be educated about mindful eating, along with other lifestyle modifications, to prevent or delay the onset of complications. Mindful eating means eating with awareness i.e., being aware of the hunger and satiety signals. All the five senses must come into play while eating: colors (eye), smells (nose), flavors (taste), textures (touch) and sound while chewing (ear) the food.

This is the first-ever study to show that diabetic neuropathy negatively impacts the chewing ability in patients with type 2 diabetes. Medical nutrition therapy therefore may not be successful in these patients, which may also affect their glycemic status. All type 2 diabetes patients must also be evaluated for mastication function, besides microvascular complications and “to control hyperglycemic conditions in diabetic neuropathy patients, diet therapy considering a patient’s masticatory function by dentists and nutritionists could be helpful,” conclude the authors.

Reference

1. Yuta Hamamoto, et al. Masticatory dysfunction in patients with diabetic neuropathy: A cross-sectional study. PLoS One. 2022 Jun 6;17(6):e0269594. doi: 10.1371/journal.pone.0269594.
2. Gudi SK. Eating speed and the risk of type 2 diabetes: explorations based on real-world evidence. Ann Pediatr Endocrinol Metab. 2020 Jun;25(2):80-83. doi: 10.6065/apem.2040028.014.