Evaluation of the Relationship Between Fasting Blood Sugar (FBS) and HbA1c Levels and Recurrent Aphthous Lesions: A Cross-Sectional Study

Evaluation of the Relationship Between Fasting Blood Sugar (FBS) and HbA1c Levels and Recurrent Aphthous Lesions: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the Relationship Between Fasting Blood Sugar (FBS) and HbA1c Levels and Recurrent Aphthous Lesions: A Cross-Sectional Study Mona Bazooband, Pezhman Hosseinpoor, Shirin Bahrami Maleki, Hamed Bahrami Maleki, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7288666/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introdution: Diabetes mellitus, a systemic metabolic disorder, has been associated with various oral mucosal conditions, including recurrent aphthous stomatitis (RAS). This study aimed to assess the relationship between fasting blood sugar (FBS) and hemoglobin A1c (HbA1c) levels in patients with RAS compared to healthy individuals. Materials and methods This cross-sectional study included 60 participants: 30 patients with RAS (≥ 3 recurrences per year) and 30 age- and sex-matched controls with no history of aphthous lesions. After obtaining informed consent, fasting blood samples were collected to measure FBS and HbA1c levels. Patients with systemic diseases were excluded. Statistical analyses were performed using SPSS version 18, including independent t-tests, Mann–Whitney U tests, and Spearman’s correlation. Results The results showed that the mean HbA1c level was significantly higher in the RAS group (5.36%) compared to the control group (4.87%) (P = 0.002), and the mean FBS level was also significantly higher in the RAS group (95.93 mg/dL vs. 85.90 mg/dL; P = 0.015). No significant difference in age or gender was observed between the two groups. Additionally, no significant association was found between the frequency of aphthous lesion recurrence and FBS or HbA1c levels (P > 0.05). Conclusion This study found that higher levels of fasting blood sugar and hemoglobin A1c were linked to an increased likelihood of developing oral aphthous lesions. In contrast, no significant correlation was observed between these glycemic markers and the frequency of lesion occurrence. Furthermore, gender did not show a significant influence on FBS or HbA1c levels. high blood sugar level oral aphthous lesions recurrent aphthous stomatitis FBS HbA1c Figures Figure 1 Figure 2 Introduction Diabetes mellitus was recognized as a chronic disease characterized by disordered metabolism of glucose, carbohydrates, lipids, and proteins, and was defined by either insufficient insulin production or an impaired cellular response to insulin [ 1 – 3 ]. Diabetes mellitus was classified into two main types. Type 1 diabetes mellitus was attributed to insufficient insulin production due to the destruction of pancreatic beta cells, whereas Type 2 diabetes mellitus was primarily associated with insulin resistance, with aging, obesity, and genetic predisposition being identified as key contributing factors [ 4 , 5 ]. Numerous studies demonstrated a significant association between diabetes mellitus and various oral pathological conditions, with periodontal disease being identified as one of the most frequently reported complications. Several mechanisms, including the formation of advanced glycation end products (AGEs), alterations in collagen structure and metabolism, impaired immune responses, and increased activation of interleukins, were proposed to contribute to this association. These mechanisms were particularly evident in poorly controlled diabetic patients and played a key role in the progression of periodontal disease [ 6 ]. Recurrent aphthous stomatitis (RAS) was described as the most common ulcerative condition of the oral mucosa. It typically presented as painful, round, shallow ulcers with a well-defined erythematous border and a yellowish-gray pseudomembranous center [ 7 ]. RAS was reported to affect approximately 5–25% of the general population, most commonly in individuals between 10 and 40 years of age. It primarily affected women and individuals from higher socioeconomic backgrounds [ 8 ]. Although its exact etiology remained unclear, oral mucosal lesions, including lichen planus and recurrent aphthous ulceration, were frequently observed in diabetic patients, despite their precise prevalence being seldom addressed in clinical studies. Some research reported an 80% prevalence of oral mucosal lesions in individuals with diabetes mellitus [ 9 ]. Recent immunological studies have confirmed that RAS involves T-cell–mediated inflammation, particularly through Th1 responses and the release of pro-inflammatory cytokines such as TNF‑α and IL‑6. Genetic susceptibility involving polymorphisms in TLR-4 and NLRP3 has also been implicated, supporting a multifactorial immune pathogenesis [ 10 ]. Increasing evidence has associated diabetes mellitus with a diminished quality of life, largely due to systemic and oral complications, including recurrent aphthous stomatitis (RAS), which contributes to physical discomfort, social limitations, and psychological distress. In response, recent studies have explored alternative management strategies for RAS, particularly herbal medicine. Natural remedies such as licorice root, aloe vera, chamomile, and myrrh have demonstrated anti-inflammatory, analgesic, and wound-healing effects, showing potential to reduce pain, lesion size, and healing time, especially in diabetic patients. These treatments may serve as complementary options to conventional therapies, particularly in chronic or recurrent cases [ 11 , 12 ]. Previous studies have explored the general prevalence of oral mucosal diseases in diabetic populations; however, limited research has specifically focused on the glycemic profiles—such as fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) levels—of patients presenting with recurrent aphthous stomatitis. While some studies suggest a possible link between altered glucose metabolism and RAS, a definitive comparison between diabetic indicators in RAS patients versus non-RAS individuals remains underexplored. A recent cross-sectional study showed that 71.5% of undiagnosed diabetic and prediabetic patients presented with oral manifestations, including ulcers and mucosal atrophy, and these findings correlated significantly with HbA1c levels [ 13 ]. Other studies have highlighted that HbA1c levels ≥ 5.7% (prediabetes) and ≥ 6.5% (diabetes) are associated with increased oral inflammatory conditions such as periodontitis and ulceration, suggesting that glycemic markers may play a diagnostic role in oral medicine [ 14 ]. The lack of focused, comparative studies on this subject represents a critical gap in the literature. Understanding this relationship could have implications for early detection of hyperglycemia and the management of recurrent oral lesions. Therefore, the rationale behind this study was to investigate whether recurrent aphthous stomatitis could serve as an early clinical indicator of impaired glucose metabolism, particularly in undiagnosed or borderline diabetic individuals. The purpose of this study was to investigate the relationship between glycemic markers—specifically fasting blood sugar (FBS) and hemoglobin A1c (HbA1c)—and the occurrence and frequency of recurrent aphthous stomatitis (RAS), as well as to evaluate the potential influence of gender on these glycemic parameters. The null hypothesis of this study stated that there would be no statistically significant difference in fasting blood sugar or HbA1c levels between patients with recurrent aphthous stomatitis and individuals without aphthous lesions. Materials and Methods This cross-sectional study was approved by the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1398.104). Two groups were enrolled, each comprising 30 participants. The case group included patients diagnosed with recurrent aphthous stomatitis (RAS) who sought treatment at the Department of Oral and Maxillofacial Diseases, School of Dentistry, Shiraz University of Medical Sciences, from 2022 to 2023. The control group consisted of individuals without any history of aphthous lesions, recruited from patients referred to the same department for routine dental examinations. The sample size of 30 participants per group was selected based on previous similar studies and resource feasibility. A post-hoc power analysis indicated that this sample size provides approximately 70% power to detect a moderate effect size (Cohen’s d = 0.6) at an alpha level of 0.05 for differences in blood glucose parameters between groups. Participants in both groups were matched individually by age (mean age approximately 37 years) and sex to minimize confounding variables. Inclusion criteria for the case group required a history of at least three episodes of RAS per year. Exclusion criteria for all participants included systemic corticosteroid or immunosuppressive medication use, autoimmune or systemic diseases affecting immune or metabolic status, and smoking. Eligible patients were identified from clinical records and invited to participate during their visits to the Oral and Maxillofacial Diseases Department. After providing informed written consent, participants underwent data collection. A 5 ml fasting blood sample was collected from each participant by a trained phlebotomist between 7:00 and 9:00 AM, following an overnight fast of at least eight hours. Fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) levels were measured using standard laboratory methods. Demographic data, including age, sex, and RAS recurrence frequency, were recorded through structured interviews and medical records. A structured screening and enrollment questionnaire was specifically developed by the research team to determine participant eligibility before laboratory testing. This questionnaire included items on demographic characteristics (age, sex), history and frequency of recurrent aphthous stomatitis (RAS), medication use, systemic conditions, smoking status, and the ability to attend for fasting blood sample collection. Participants were provided with the questionnaire prior to their laboratory visit to ensure they met all inclusion and exclusion criteria. The English version of this questionnaire is provided as a supplementary file (Supplementary File 1). Data were analyzed using SPSS version 18. The normality of continuous variables was assessed with the Shapiro-Wilk test. Age was compared between groups using the independent samples t-test. Because FBS and HbA1c values were non-normally distributed, the Mann–Whitney U test was used to compare these variables between groups. Spearman’s rank correlation coefficient assessed the relationship between blood glucose levels and the frequency of RAS episodes. Effect sizes (r for nonparametric tests and Cohen’s d for t-tests) and 95% confidence intervals were calculated and reported where applicable. Statistical significance was set at p < 0.05. Result This study was performed to evaluate the relationship between FBS and HbA1c levels and the occurrence of aphthous ulcers. Thirty participants were enrolled in two groups, which included aphthous and non-aphthous individuals. The data distribution was found to be non-normal, so the Mann–Whitney U test was used for statistical analysis. Group Mean N Std. Deviation Minimum Maximum p- value aphthous 37.03 30 11.39 20.00 71.00 0.949 without aphthous 37.23 30 12.90 22.00 73.00 Table 1: Frequency of aphthous group and non-aphthous group age Table 1 shows that a total of 60 cases were analyzed, 30 had no history of aphthous ulcers and 30 patients were suffering from RAS. Age evaluation of the two groups shows that the mean age in patients with RAS was 37.03; with minimum age 20 and maximum 71 years, and in individuals without history of aphthous ulcers; mean age was 37.23 with minimum age 22and maximum 73 years. There was no significant difference between these two groups, because the samples were selected homogeneously(P>0.05). Table 2: Comparison of mean levels FBS and HbA1c by gender The results of table 2 demonstrate that there is no significant difference between HbA1c (P-value = 0.437), FBS levels(P-value = 0.165) and type of gender. Also; there was no significant difference between the average age of people in both sexes(P-value = 0.899). Table 3: Comparison of FBS and HbA1c levels in two groups The mean levels of FBS and HbA1c in evaluated groups are presented in Table 3. The comparison of these values between patients with RAS and participants in control group are also reported in Table 4. According to the results, the mean HbA1c level (%5.36) was significantly more in patients with RAS than control participants (%4.87) (P-value = 0.002). The mean FBS level was 95.93 in aphthous patients that was more in comparison with the average FBS level in control group which was 85.90. (p-value = 0.015) This difference in mean level of blood tests was statistically significant (P < 0.05). Table 4 Evaluation of the relationship between the mean level of FBS and HbA1c with the frequency of oral aphthous lesions freq N Mean Std. Deviation Std.Error Mean p-value HbA1c 3–5 25 5.376 0.709 0.141 0.787 > 5 5 5.320 0.759 0.339 FBS 3–5 25 95.08 21.201 4.240 0.275 > 5 5 100.200 14.601 6.529 The results in Table 4 showed Comparison of 25 patients with RAS Who had recurrence of aphthous ulcers 3–5 times a year with 5 people suffering from aphthous ulcers more than 5 times a year. There was no significant difference in FBS and HbA1c levels(P > 0.05). Discussion According to the results, the mean HbA1c and FBS levels in patients with RAS were significantly higher than those in the control group (p-values = 0.002 and 0.015, respectively); therefore, the null hypothesis was rejected. However, based on standard clinical cutoffs defined by the American Diabetes Association, none of the participants in the RAS group had HbA1c or FBS values within the prediabetic or diabetic range [ 15 ]. All glycemic values remained within clinically accepted normal limits. Although the RAS group demonstrated statistically higher mean levels, these differences did not reach thresholds indicative of a metabolic disorder. In addition, no significant relationship was observed between the frequency of aphthous lesions and HbA1c or FBS levels (p-values = 0.787 and 0.275, respectively). The presence of oral mucosal lesions, such as lichen planus and recurrent aphthous ulcers, has frequently been diagnosed in diabetic patients in previous studies [ 16 ]. In most similar studies, diabetic and non-diabetic patients were recruited, and the prevalence of oral lesions was evaluated through comparison. However, a different sample selection criterion was applied in the present study. Two groups were established—one consisting of patients with RAS, and the other comprising individuals without a history of aphthous ulcers. Emphasis was placed on blood sugar levels rather than on known diabetic status, which served as a point of distinction in this research. Silva et al. (2015), in a cross-sectional observational study conducted between August and October, employed convenience sampling for 51 patients with diabetes mellitus. The results indicated a high prevalence of oral mucosal lesions in diabetic patients, mostly associated with type 2 diabetes [ 6 ]. Similarly, it was observed in the present study that individuals with RAS had higher blood sugar levels. In a cross-sectional study conducted in Brazil in 2017, Trentin et al. investigated the main oral changes in patients with diabetes mellitus type 2 and non-diabetics. A total of 116 diabetic and 134 non-diabetic patients were examined, and a higher prevalence of oral lesions was found in diabetic patients [ 17 ]. However, the similarity in age, sex, and the number of cases across both groups was not considered. A study by Bastos et al., including 146 patients with diabetes mellitus type 2 and 111 non-diabetic controls, demonstrated that nearly twice as many diabetic patients (88%) had one or more oral soft tissue lesions compared to non-diabetic controls (45%), with the difference being statistically significant (P < 0.001) [ 9 ]. Although the number of participants in both groups was unequal in that study, an equal number of participants was maintained in the present research to allow accurate comparison. Saini R et al. conducted a cross-sectional study involving 420 diabetic and 420 non-diabetic control subjects without oral habits. A significantly higher prevalence of oral mucosal lesions was observed in diabetic patients, and this prevalence was found to be associated with the metabolic control of the disease. However, no association was noted between diabetes mellitus and oral precancerous lesions [ 18 ]. Matching of sex and age was not performed in their study. In a 2024 study by Mishra et al., 220 participants—110 with diabetes mellitus type 2 and 110 healthy controls—were examined to assess and compare the prevalence of oral mucosal lesions. A significantly higher prevalence was found in diabetic patients (79.09%) compared to controls (53.64%). The most common lesion in both groups was reported as coated tongue, followed by burning sensation and candidiasis. While the study emphasized general oral lesions in diabetics, the current study focused on the correlation between RAS and FBS/HbA1c levels. Furthermore, the participant number in the former study was approximately 1.5 times greater in the diabetic group, and gender distribution was not reported, unlike the matched age, sex, and sample size in this study [ 19 ]. A significant association between disease metabolic control and the occurrence of oral lesions was demonstrated in a 2013 study by Al-Maweri et al. in Malaysia. A total of 391 diabetic and 391 non-diabetic individuals were included. Oral mucosal lesions were more prevalent among diabetic patients (45.5%) than controls (38.4%) (P = 0.042), and poorer metabolic control was linked with increased RAS risk [ 20 ]. Although participant numbers were matched, age and sex matching were not performed. Only one study was found to have measured FBS and postprandial glucose (2-hour blood glucose) levels. Bajaj et al. conducted a comparative study involving 50 diabetic patients with oral complications and 50 age- and sex-matched diabetic patients without such complications. The mean FBS level in the group with oral complications was reported as 168.2, while in the complication-free group it was 137.4. A similar relationship was identified for Postprandial Blood Glucose levels (215 in those with complications vs. 177 in those without) [ 21 ]. Although the present study also indicated that RAS patients had higher FBS and HbA1c levels, the mean FBS level was lower compared to that in the Bajaj study, possibly due to differences in sample size. Numerous studies have specifically addressed the relationship between oral lichen planus and diabetes mellitus. Al-Maweri et al. (2019) conducted a study of 150 diabetes mellitus type 2 patients and 150 healthy controls to assess the prevalence of oral mucosal lesions, including aphthous stomatitis. A significantly higher prevalence was found in diabetic patients [ 22 ]. However, the association between blood glucose markers (FBS, HbA1c) and aphthous lesions was not investigated in that study. In contrast, the current study specifically examined this biochemical relationship. Djebabli et al. (2022) investigated the prevalence and characteristics of oral lichen planus (OLP) in diabetic patients in Tunisia. A total of 44 individuals diagnosed with OLP were assessed. Among them, 22.72% were found to have diabetes. Although OLP lesions were more extensive in diabetic patients, no significant differences in lesion type or clinical presentation were identified. The study suggested a potential association between diabetes and OLP severity [ 23 ]. While that research focused on OLP in diabetics, the present study investigated the relationship between FBS, HbA1c, and RAS. While this study provides valuable insights into the association between glycemic markers and recurrent aphthous stomatitis (RAS), several limitations should be acknowledged. First, the cross-sectional design limits the ability to establish a causal relationship between elevated fasting blood sugar (FBS) or hemoglobin A1c (HbA1c) levels and the development of aphthous lesions. Longitudinal studies are needed to confirm these associations over time. Second, although the overall sample size was sufficient to detect general trends, it may not fully represent the broader population. Future research with a larger and more diverse cohort is recommended to enhance the generalizability of the findings. In particular, the subgroup of participants who reported experiencing more than five episodes of RAS per year included five individuals. This limited number may reduce the statistical power to some extent, and as a result, findings related to high-frequency RAS should be interpreted with additional caution. Third, the study relied on self-reported data regarding the frequency of aphthous lesions, which may be subject to recall bias. Incorporating objective clinical documentation over a defined observational period could strengthen the accuracy of future studies. Additionally, several potential confounding variables—such as psychological stress, dietary habits, immune function, and vitamin or micronutrient deficiencies—were not assessed in this study, despite their potential role in the onset or recurrence of RAS. Future research should explore these factors and further investigate the biological mechanisms that may link glycemic control to oral mucosal health. Interventional studies assessing whether improved glycemic regulation can reduce the frequency or severity of RAS would also be valuable. Conclusion The findings of this study indicate that elevated fasting blood sugar (FBS) and hemoglobin A1c (HbA1c) levels are associated with an increased risk of developing oral aphthous lesions. However, no significant association was found between glycemic markers and the frequency of these lesions. Additionally, gender did not appear to have a significant effect on FBS or HbA1c levels. Abbreviations FBS: Fasting Blood Sugar; HbA1C: hemoglobin A1C; RAS: Recurrent aphthous stomatitis; OLP: Oral Lichen Planus; Th1: T helper 1 cell; TNF-α: Tumor Necrosis Factor alpha; IL-6: Interleukin-6; TLR-4: Toll-like receptor 4; NLRP3: nucleotide-binding domain, leucine-rich repeat, and pyrin domain-containing protein 3 inflammasome. Declarations Ethics approval and consent to participate: The study was approved by the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1398.104). Written informed consent was obtained from all participants prior to their inclusion in the study. Consent for publication: Not applicable. No individual personal data are included in this study. Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. At this time, the data are not publicly available via a specific repository, but can be shared for research purposes upon request. Competing Interests: The authors declare that they have no competing interest. Funding: This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. No funding number is applicable. Authors' contributions: M. Bazooband, P. Hosseinpoor, S. Bahrami Maleki, H. Bahrami Maleki, and M. Moshaverinia contributed to the conception and design of the study, data acquisition, and interpretation of results. All authors participated in drafting the manuscript and critically revising it for important intellectual content. Each author read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work. Acknowledgements: The authors would like to express their gratitude to all participants who contributed to this study. No financial or other specific acknowledgements are declared. References American Diabetes Association. Classification and diagnosis of diabetes: Standards of medical care in diabetes—2022. Diabetes Care. 2022;45(Suppl 1): S17–S38. Zhou Y, Hu J, Zhang H, Li X, Liu L. Pathophysiology of diabetes mellitus and its complications: the role of insulin resistance and beta-cell dysfunction. Diabetes Metab Syndr Obes. 2020; 13:451–60. Galtier F. Definition, epidemiology, risk factors. Diabetes Metab. 2010;36(6 Pt 2):628–51. PMID: 21163426. Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014;383(9911):69–82. Leslie RD. Predicting adult-onset autoimmune diabetes: clarity from complexity. Diabetes. 2010;59(2):330–1. Silva M, Barbosa K, Pereira J, Bento P, Godoy G, Gomes D. Prevalence of oral mucosal lesions among patients with diabetes mellitus types 1 and 2. An Bras Dermatol. 2015;90(1):49–53. Au CB, Smith GP. Recurrent aphthous stomatitis: A comprehensive review and recommendations on therapeutic options. Dermatol Ther. 2022;35(6): e15500. Patil S, Reddy SN, Maheshwari S, Khandelwal S, Doni B, Sandhu S. Prevalence and comparison of recurrent aphthous stomatitis in different socio-economic groups and its impact on quality of life: a cross-sectional study. J Clin Diagn Res. 2017;11(12): ZC06–ZC09. Bastos AdS, Leite ARP, Spin-Neto R, Nassar PcO, Massucato EMS, Orrico SRP. Diabetes mellitus and oral mucosa alterations: prevalence and risk factors. Diabetes Res Clin Pract. 2011;92(1):100–5. Yuan Y, Ma X, Liu Y, et al. Emerging insights into the immunopathogenesis of recurrent aphthous stomatitis: a review. Clin Oral Investig. 2023;27(4):1093–1101. Karobari MI, Selvaraj S, Adil AH, Marya A. Modifiable and non-modifiable risk factors affecting oral and periodontal health and quality of life in South Asia. Open Dent J. 2022; 16: e2209270. Kathayat G, Selvido DI, Skallevold HE, Rokaya MB, Bhattarai BP, Marya A, et al. Natural oral care and herbal products for oral diseases and oral hygiene maintenance. In: Chauhan DN, Singh PR, Chauhan NS, Shah K, editors. Herbal Medicines: Recent Trends and Developments. Hoboken (NJ): Wiley; 2023. Chapter 3. Khan S, Abbas S, Ali Z, et al. Association of oral manifestations with undiagnosed diabetes and prediabetes. J Pak Med Assoc. 2023;73(3):590–594. Sato K, Miura H, Arai K. Glycemic control thresholds and their relationship with oral complications in patients with type 2 diabetes: a cross-sectional study. BMC Oral Health. 2022; 22:467. American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes—2022. Diabetes Care. 2022;45(Suppl 1): S17–S38. Ahmed W, Smith R, Wilson G. Prevalence of oral mucosal lesions in diabetic patients. J Dent Res. 2023;102(2):221–5. Trentin M, Verardi G, Ferreira MDC, Carli Jd, Silva Sd, Lima I, et al. Most frequent oral lesions in patients with type 2 diabetes mellitus. J Contemp Dent Pract. 2017;18(2):107–11. doi:10.5005/jp-journals-10024-2004. Saini R, Al-Maweri S, Saini D, Ismail N, Ismail A. Oral mucosal lesions in non-oral habit diabetic patients and association of diabetes mellitus with oral precancerous lesions. Diabetes Res Clin Pract. 2010;89(3):320–6. Mishra S, Shukla A, Yadav P, Tiwari P, Chaturvedi P. A comparative study on oral mucosal lesions among type 2 diabetes mellitus patients and non-diabetics. Asian J Pharm Clin Res. 2024;17(1):148–52. Al-Maweri SAA, Ismail NM, Ismail AR, Al-Ghashm A. Prevalence of oral mucosal lesions in patients with type 2 diabetes attending Hospital Universiti Sains Malaysia. Malays J Med Sci. 2013;20(4):39–46. Bajaj S, Prasad S, Gupta A, Singh V. Oral manifestations in type-2 diabetes and related complications. Indian J Endocrinol Metab. 2012;16(5):777–9. Al-Maweri SAA, Ismail NM, Ismail AR, Al-Ghashm A. Prevalence of oral mucosal lesions in patients with type 2 diabetes attending Hospital Universiti Sains Malaysia. Malays J Med Sci. 2019;26(2):43–51. Djebabli N, Chelly W, Chaaben A, Bouguila J, Soua M, Ghedira H, et al. Oral lichen planus and diabetes mellitus: prevalence and clinical features (Tunisian experience). Int J Frontline Res Life Sci. 2022;1(1):1–8. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.ScreeningandEligibilityQuestionnaire.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7288666","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":512050335,"identity":"c0b6eeb2-585e-4fa0-8838-7b48a5d81599","order_by":0,"name":"Mona Bazooband","email":"","orcid":"","institution":"Shiraz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mona","middleName":"","lastName":"Bazooband","suffix":""},{"id":512050336,"identity":"143ac224-32c1-4280-a90f-d8b517121f4b","order_by":1,"name":"Pezhman Hosseinpoor","email":"","orcid":"","institution":"Independent Researcher","correspondingAuthor":false,"prefix":"","firstName":"Pezhman","middleName":"","lastName":"Hosseinpoor","suffix":""},{"id":512050337,"identity":"c13236f1-625b-44a1-8d7e-2099b5ba3832","order_by":2,"name":"Shirin Bahrami Maleki","email":"","orcid":"","institution":"Independent Researcher","correspondingAuthor":false,"prefix":"","firstName":"Shirin","middleName":"Bahrami","lastName":"Maleki","suffix":""},{"id":512050338,"identity":"db469535-beef-4573-bc29-fe93013768e6","order_by":3,"name":"Hamed Bahrami Maleki","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYBACAxDB28CQAKIPfCBZy8EZJGth5iFGizn76cQHb3fY5Zm3n048bJtjw8Df3p2AV4tlT+5mw7lnkotlzuRuOJy7LY1B4szZDfgddiB3mzRvG3PiDAawlsMMBhK5BLScf7v9N29bfeIM/rcbDltu+0+Elhu525h52w4nzgCqPMy47QAxWt5ulpx75jhQy9sNB3u3JfMQ9sv53I0f3u6oBjosd/OHn9vs5Pjbe/FrwQBERc0oGAWjYBSMAgIAAKlFUWs4uzYhAAAAAElFTkSuQmCC","orcid":"","institution":"Ilam University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Hamed","middleName":"Bahrami","lastName":"Maleki","suffix":""},{"id":512050339,"identity":"71a080b1-5ab9-4e91-8ba6-0a0e7bfac8d1","order_by":4,"name":"Maryam Moshaverinia","email":"","orcid":"","institution":"Shiraz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Moshaverinia","suffix":""}],"badges":[],"createdAt":"2025-08-04 08:23:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7288666/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7288666/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91306247,"identity":"e245f964-0bdc-4e7d-991f-915f88ca168f","added_by":"auto","created_at":"2025-09-15 06:31:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":91829,"visible":true,"origin":"","legend":"\u003cp\u003eBar chart illustrating the comparison of mean HbA1c, fasting blood sugar (FBS), and age between male and female participants, as reported in Table 2.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7288666/v1/1975abb20e445f4801298980.png"},{"id":91306252,"identity":"1f26dea1-75f8-4ab8-8751-81f0edae5f53","added_by":"auto","created_at":"2025-09-15 06:31:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":65627,"visible":true,"origin":"","legend":"\u003cp\u003eBar chart comparing mean HbA1c and fasting blood sugar (FBS) levels between participants with and without recurrent aphthous stomatitis (RAS), based on Table 3.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7288666/v1/113da61cc1195731814bdc83.png"},{"id":107337043,"identity":"cb78ccee-3009-4a72-a5e8-9ac009f326d8","added_by":"auto","created_at":"2026-04-20 13:42:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":462696,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7288666/v1/690fcd0a-e997-406b-b80c-669740980f47.pdf"},{"id":91306249,"identity":"cb8efdcf-66d7-445f-abec-508e7acd0ac1","added_by":"auto","created_at":"2025-09-15 06:31:19","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":14391,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.ScreeningandEligibilityQuestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-7288666/v1/e4023220a771da6677acffad.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of the Relationship Between Fasting Blood Sugar (FBS) and HbA1c Levels and Recurrent Aphthous Lesions: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDiabetes mellitus was recognized as a chronic disease characterized by disordered metabolism of glucose, carbohydrates, lipids, and proteins, and was defined by either insufficient insulin production or an impaired cellular response to insulin [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDiabetes mellitus was classified into two main types. Type 1 diabetes mellitus was attributed to insufficient insulin production due to the destruction of pancreatic beta cells, whereas Type 2 diabetes mellitus was primarily associated with insulin resistance, with aging, obesity, and genetic predisposition being identified as key contributing factors [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNumerous studies demonstrated a significant association between diabetes mellitus and various oral pathological conditions, with periodontal disease being identified as one of the most frequently reported complications. Several mechanisms, including the formation of advanced glycation end products (AGEs), alterations in collagen structure and metabolism, impaired immune responses, and increased activation of interleukins, were proposed to contribute to this association. These mechanisms were particularly evident in poorly controlled diabetic patients and played a key role in the progression of periodontal disease [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRecurrent aphthous stomatitis (RAS) was described as the most common ulcerative condition of the oral mucosa. It typically presented as painful, round, shallow ulcers with a well-defined erythematous border and a yellowish-gray pseudomembranous center [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. RAS was reported to affect approximately 5\u0026ndash;25% of the general population, most commonly in individuals between 10 and 40 years of age. It primarily affected women and individuals from higher socioeconomic backgrounds [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough its exact etiology remained unclear, oral mucosal lesions, including lichen planus and recurrent aphthous ulceration, were frequently observed in diabetic patients, despite their precise prevalence being seldom addressed in clinical studies. Some research reported an 80% prevalence of oral mucosal lesions in individuals with diabetes mellitus [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRecent immunological studies have confirmed that RAS involves T-cell\u0026ndash;mediated inflammation, particularly through Th1 responses and the release of pro-inflammatory cytokines such as TNF‑α and IL‑6. Genetic susceptibility involving polymorphisms in TLR-4 and NLRP3 has also been implicated, supporting a multifactorial immune pathogenesis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIncreasing evidence has associated diabetes mellitus with a diminished quality of life, largely due to systemic and oral complications, including recurrent aphthous stomatitis (RAS), which contributes to physical discomfort, social limitations, and psychological distress. In response, recent studies have explored alternative management strategies for RAS, particularly herbal medicine. Natural remedies such as licorice root, aloe vera, chamomile, and myrrh have demonstrated anti-inflammatory, analgesic, and wound-healing effects, showing potential to reduce pain, lesion size, and healing time, especially in diabetic patients. These treatments may serve as complementary options to conventional therapies, particularly in chronic or recurrent cases [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrevious studies have explored the general prevalence of oral mucosal diseases in diabetic populations; however, limited research has specifically focused on the glycemic profiles\u0026mdash;such as fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) levels\u0026mdash;of patients presenting with recurrent aphthous stomatitis. While some studies suggest a possible link between altered glucose metabolism and RAS, a definitive comparison between diabetic indicators in RAS patients versus non-RAS individuals remains underexplored.\u003c/p\u003e\u003cp\u003eA recent cross-sectional study showed that 71.5% of undiagnosed diabetic and prediabetic patients presented with oral manifestations, including ulcers and mucosal atrophy, and these findings correlated significantly with HbA1c levels [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOther studies have highlighted that HbA1c levels\u0026thinsp;\u0026ge;\u0026thinsp;5.7% (prediabetes) and \u0026ge;\u0026thinsp;6.5% (diabetes) are associated with increased oral inflammatory conditions such as periodontitis and ulceration, suggesting that glycemic markers may play a diagnostic role in oral medicine [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe lack of focused, comparative studies on this subject represents a critical gap in the literature. Understanding this relationship could have implications for early detection of hyperglycemia and the management of recurrent oral lesions. Therefore, the rationale behind this study was to investigate whether recurrent aphthous stomatitis could serve as an early clinical indicator of impaired glucose metabolism, particularly in undiagnosed or borderline diabetic individuals.\u003c/p\u003e\u003cp\u003eThe purpose of this study was to investigate the relationship between glycemic markers\u0026mdash;specifically fasting blood sugar (FBS) and hemoglobin A1c (HbA1c)\u0026mdash;and the occurrence and frequency of recurrent aphthous stomatitis (RAS), as well as to evaluate the potential influence of gender on these glycemic parameters.\u003c/p\u003e\u003cp\u003eThe null hypothesis of this study stated that there would be no statistically significant difference in fasting blood sugar or HbA1c levels between patients with recurrent aphthous stomatitis and individuals without aphthous lesions.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e This cross-sectional study was approved by the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1398.104). Two groups were enrolled, each comprising 30 participants. The case group included patients diagnosed with recurrent aphthous stomatitis (RAS) who sought treatment at the Department of Oral and Maxillofacial Diseases, School of Dentistry, Shiraz University of Medical Sciences, from 2022 to 2023. The control group consisted of individuals without any history of aphthous lesions, recruited from patients referred to the same department for routine dental examinations.\u003c/p\u003e\u003cp\u003eThe sample size of 30 participants per group was selected based on previous similar studies and resource feasibility. A post-hoc power analysis indicated that this sample size provides approximately 70% power to detect a moderate effect size (Cohen’s d = 0.6) at an alpha level of 0.05 for differences in blood glucose parameters between groups.\u003c/p\u003e\u003cp\u003eParticipants in both groups were matched individually by age (mean age approximately 37 years) and sex to minimize confounding variables. Inclusion criteria for the case group required a history of at least three episodes of RAS per year. Exclusion criteria for all participants included systemic corticosteroid or immunosuppressive medication use, autoimmune or systemic diseases affecting immune or metabolic status, and smoking.\u003c/p\u003e\u003cp\u003eEligible patients were identified from clinical records and invited to participate during their visits to the Oral and Maxillofacial Diseases Department. After providing informed written consent, participants underwent data collection.\u003c/p\u003e\u003cp\u003eA 5 ml fasting blood sample was collected from each participant by a trained phlebotomist between 7:00 and 9:00 AM, following an overnight fast of at least eight hours. Fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) levels were measured using standard laboratory methods.\u003c/p\u003e\u003cp\u003eDemographic data, including age, sex, and RAS recurrence frequency, were recorded through structured interviews and medical records.\u003c/p\u003e\u003cp\u003eA structured screening and enrollment questionnaire was specifically developed by the research team to determine participant eligibility before laboratory testing. This questionnaire included items on demographic characteristics (age, sex), history and frequency of recurrent aphthous stomatitis (RAS), medication use, systemic conditions, smoking status, and the ability to attend for fasting blood sample collection. Participants were provided with the questionnaire prior to their laboratory visit to ensure they met all inclusion and exclusion criteria. The English version of this questionnaire is provided as a supplementary file (Supplementary File 1).\u003c/p\u003e\u003cp\u003eData were analyzed using SPSS version 18. The normality of continuous variables was assessed with the Shapiro-Wilk test. Age was compared between groups using the independent samples t-test. Because FBS and HbA1c values were non-normally distributed, the Mann–Whitney U test was used to compare these variables between groups. Spearman’s rank correlation coefficient assessed the relationship between blood glucose levels and the frequency of RAS episodes.\u003c/p\u003e\u003cp\u003eEffect sizes (r for nonparametric tests and Cohen’s d for t-tests) and 95% confidence intervals were calculated and reported where applicable. Statistical significance was set at p \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Result","content":"\u003cdiv\u003e\n \u003cdiv align=\"left\"\u003eThis study was performed to evaluate the relationship between FBS and HbA1c levels and the occurrence of aphthous ulcers. Thirty participants were enrolled in two groups, which included aphthous and non-aphthous individuals. The data distribution was found to be non-normal, so the Mann\u0026ndash;Whitney U test was used for statistical analysis.\u003c/div\u003e\n \u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep- value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eaphthous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e71.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.949\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewithout aphthous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e73.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 1: Frequency of aphthous group and non-aphthous group age\u003c/p\u003e\n\u003cdiv\u003e\n \u003cdiv align=\"left\"\u003eTable 1 shows that a total of 60 cases were analyzed, 30 had no history of aphthous ulcers and 30 patients were suffering from RAS. Age evaluation of the two groups shows that the mean age in patients with RAS was 37.03; with minimum age 20 and maximum 71 years, and in individuals without history of aphthous ulcers; mean age was 37.23 with minimum age 22and maximum 73 years. There was no significant difference between these two groups, because the samples were selected homogeneously(P\u0026gt;0.05).\u003c/div\u003e\n \u003cdiv align=\"left\"\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/div\u003e\n \u003cdiv align=\"left\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\"\u003eTable 2: Comparison of mean levels FBS and HbA1c by gender\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003eThe results of table 2 demonstrate that there is no significant difference between HbA1c (P-value\u0026thinsp;=\u0026thinsp;0.437), FBS levels(P-value\u0026thinsp;=\u0026thinsp;0.165) and type of gender. Also; there was no significant difference between the average age of people in both sexes(P-value\u0026thinsp;=\u0026thinsp;0.899).\u003c/p\u003e\n\u003cdiv align=\"left\"\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/div\u003e\n\u003cdiv align=\"left\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003cdiv align=\"left\"\u003eTable 3: Comparison of FBS and HbA1c levels in two groups\u003c/div\u003e\n\u003cp\u003eThe mean levels of FBS and HbA1c in evaluated groups are presented in Table 3. The comparison of these values between patients with RAS and participants in control group are also reported in Table 4. According to the results, the mean HbA1c level (%5.36) was significantly more in patients with RAS than control participants (%4.87) (P-value\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\n\u003cp\u003eThe mean FBS level was 95.93 in aphthous patients that was more in comparison with the average FBS level in control group which was 85.90. (p-value\u0026thinsp;=\u0026thinsp;0.015) This difference in mean level of blood tests was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eEvaluation of the relationship between the mean level of FBS and HbA1c with the frequency of oral aphthous lesions\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003efreq\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStd.Error Mean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHbA1c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u0026ndash;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.787\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.339\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFBS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u0026ndash;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100.200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.529\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe results in Table 4 showed Comparison of 25 patients with RAS Who had recurrence of aphthous ulcers 3\u0026ndash;5 times a year with 5 people suffering from aphthous ulcers more than 5 times a year. There was no significant difference in FBS and HbA1c levels(P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAccording to the results, the mean HbA1c and FBS levels in patients with RAS were significantly higher than those in the control group (p-values\u0026thinsp;=\u0026thinsp;0.002 and 0.015, respectively); therefore, the null hypothesis was rejected. However, based on standard clinical cutoffs defined by the American Diabetes Association, none of the participants in the RAS group had HbA1c or FBS values within the prediabetic or diabetic range [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. All glycemic values remained within clinically accepted normal limits. Although the RAS group demonstrated statistically higher mean levels, these differences did not reach thresholds indicative of a metabolic disorder. In addition, no significant relationship was observed between the frequency of aphthous lesions and HbA1c or FBS levels (p-values\u0026thinsp;=\u0026thinsp;0.787 and 0.275, respectively).\u003c/p\u003e\u003cp\u003eThe presence of oral mucosal lesions, such as lichen planus and recurrent aphthous ulcers, has frequently been diagnosed in diabetic patients in previous studies [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e In most similar studies, diabetic and non-diabetic patients were recruited, and the prevalence of oral lesions was evaluated through comparison. However, a different sample selection criterion was applied in the present study. Two groups were established\u0026mdash;one consisting of patients with RAS, and the other comprising individuals without a history of aphthous ulcers. Emphasis was placed on blood sugar levels rather than on known diabetic status, which served as a point of distinction in this research.\u003c/p\u003e\u003cp\u003eSilva et al. (2015), in a cross-sectional observational study conducted between August and October, employed convenience sampling for 51 patients with diabetes mellitus. The results indicated a high prevalence of oral mucosal lesions in diabetic patients, mostly associated with type 2 diabetes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Similarly, it was observed in the present study that individuals with RAS had higher blood sugar levels.\u003c/p\u003e\u003cp\u003eIn a cross-sectional study conducted in Brazil in 2017, Trentin et al. investigated the main oral changes in patients with diabetes mellitus type 2 and non-diabetics. A total of 116 diabetic and 134 non-diabetic patients were examined, and a higher prevalence of oral lesions was found in diabetic patients [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, the similarity in age, sex, and the number of cases across both groups was not considered.\u003c/p\u003e\u003cp\u003eA study by Bastos et al., including 146 patients with diabetes mellitus type 2 and 111 non-diabetic controls, demonstrated that nearly twice as many diabetic patients (88%) had one or more oral soft tissue lesions compared to non-diabetic controls (45%), with the difference being statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Although the number of participants in both groups was unequal in that study, an equal number of participants was maintained in the present research to allow accurate comparison.\u003c/p\u003e\u003cp\u003eSaini R et al. conducted a cross-sectional study involving 420 diabetic and 420 non-diabetic control subjects without oral habits. A significantly higher prevalence of oral mucosal lesions was observed in diabetic patients, and this prevalence was found to be associated with the metabolic control of the disease. However, no association was noted between diabetes mellitus and oral precancerous lesions [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Matching of sex and age was not performed in their study.\u003c/p\u003e\u003cp\u003eIn a 2024 study by Mishra et al., 220 participants\u0026mdash;110 with diabetes mellitus type 2 and 110 healthy controls\u0026mdash;were examined to assess and compare the prevalence of oral mucosal lesions. A significantly higher prevalence was found in diabetic patients (79.09%) compared to controls (53.64%). The most common lesion in both groups was reported as coated tongue, followed by burning sensation and candidiasis. While the study emphasized general oral lesions in diabetics, the current study focused on the correlation between RAS and FBS/HbA1c levels. Furthermore, the participant number in the former study was approximately 1.5 times greater in the diabetic group, and gender distribution was not reported, unlike the matched age, sex, and sample size in this study [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA significant association between disease metabolic control and the occurrence of oral lesions was demonstrated in a 2013 study by Al-Maweri et al. in Malaysia. A total of 391 diabetic and 391 non-diabetic individuals were included. Oral mucosal lesions were more prevalent among diabetic patients (45.5%) than controls (38.4%) (P\u0026thinsp;=\u0026thinsp;0.042), and poorer metabolic control was linked with increased RAS risk [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Although participant numbers were matched, age and sex matching were not performed.\u003c/p\u003e\u003cp\u003eOnly one study was found to have measured FBS and postprandial glucose (2-hour blood glucose) levels.\u003c/p\u003e\u003cp\u003eBajaj et al. conducted a comparative study involving 50 diabetic patients with oral complications and 50 age- and sex-matched diabetic patients without such complications. The mean FBS level in the group with oral complications was reported as 168.2, while in the complication-free group it was 137.4. A similar relationship was identified for Postprandial Blood Glucose levels (215 in those with complications vs. 177 in those without) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Although the present study also indicated that RAS patients had higher FBS and HbA1c levels, the mean FBS level was lower compared to that in the Bajaj study, possibly due to differences in sample size.\u003c/p\u003e\u003cp\u003eNumerous studies have specifically addressed the relationship between oral lichen planus and diabetes mellitus.\u003c/p\u003e\u003cp\u003eAl-Maweri et al. (2019) conducted a study of 150 diabetes mellitus type 2 patients and 150 healthy controls to assess the prevalence of oral mucosal lesions, including aphthous stomatitis. A significantly higher prevalence was found in diabetic patients [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, the association between blood glucose markers (FBS, HbA1c) and aphthous lesions was not investigated in that study. In contrast, the current study specifically examined this biochemical relationship.\u003c/p\u003e\u003cp\u003eDjebabli et al. (2022) investigated the prevalence and characteristics of oral lichen planus (OLP) in diabetic patients in Tunisia. A total of 44 individuals diagnosed with OLP were assessed. Among them, 22.72% were found to have diabetes. Although OLP lesions were more extensive in diabetic patients, no significant differences in lesion type or clinical presentation were identified. The study suggested a potential association between diabetes and OLP severity [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. While that research focused on OLP in diabetics, the present study investigated the relationship between FBS, HbA1c, and RAS.\u003c/p\u003e\u003cp\u003eWhile this study provides valuable insights into the association between glycemic markers and recurrent aphthous stomatitis (RAS), several limitations should be acknowledged.\u003c/p\u003e\u003cp\u003eFirst, the cross-sectional design limits the ability to establish a causal relationship between elevated fasting blood sugar (FBS) or hemoglobin A1c (HbA1c) levels and the development of aphthous lesions. Longitudinal studies are needed to confirm these associations over time.\u003c/p\u003e\u003cp\u003eSecond, although the overall sample size was sufficient to detect general trends, it may not fully represent the broader population. Future research with a larger and more diverse cohort is recommended to enhance the generalizability of the findings. In particular, the subgroup of participants who reported experiencing more than five episodes of RAS per year included five individuals. This limited number may reduce the statistical power to some extent, and as a result, findings related to high-frequency RAS should be interpreted with additional caution.\u003c/p\u003e\u003cp\u003eThird, the study relied on self-reported data regarding the frequency of aphthous lesions, which may be subject to recall bias. Incorporating objective clinical documentation over a defined observational period could strengthen the accuracy of future studies.\u003c/p\u003e\u003cp\u003eAdditionally, several potential confounding variables\u0026mdash;such as psychological stress, dietary habits, immune function, and vitamin or micronutrient deficiencies\u0026mdash;were not assessed in this study, despite their potential role in the onset or recurrence of RAS.\u003c/p\u003e\u003cp\u003eFuture research should explore these factors and further investigate the biological mechanisms that may link glycemic control to oral mucosal health. Interventional studies assessing whether improved glycemic regulation can reduce the frequency or severity of RAS would also be valuable.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study indicate that elevated fasting blood sugar (FBS) and hemoglobin A1c (HbA1c) levels are associated with an increased risk of developing oral aphthous lesions. However, no significant association was found between glycemic markers and the frequency of these lesions. Additionally, gender did not appear to have a significant effect on FBS or HbA1c levels.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFBS: Fasting Blood Sugar; HbA1C: hemoglobin A1C; RAS: Recurrent aphthous stomatitis; OLP: Oral Lichen Planus; Th1: T helper 1 cell; TNF-\u0026alpha;: Tumor Necrosis Factor alpha; IL-6: Interleukin-6; TLR-4: Toll-like receptor 4; NLRP3: nucleotide-binding domain, leucine-rich repeat, and pyrin domain-containing protein 3 inflammasome.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The study was approved by the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1398.104). Written informed consent was obtained from all participants prior to their inclusion in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable. No individual personal data are included in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. At this time, the data are not publicly available via a specific repository, but can be shared for research purposes upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare that they have no competing interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. No funding number is applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;M. Bazooband, P. Hosseinpoor, S. Bahrami Maleki, H. Bahrami Maleki, and M. Moshaverinia contributed to the conception and design of the study, data acquisition, and interpretation of results. All authors participated in drafting the manuscript and critically revising it for important intellectual content. Each author read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors would like to express their gratitude to all participants who contributed to this study. No financial or other specific acknowledgements are declared.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmerican Diabetes Association. Classification and diagnosis of diabetes: Standards of medical care in diabetes\u0026mdash;2022. Diabetes Care. 2022;45(Suppl 1): S17\u0026ndash;S38.\u003c/li\u003e\n\u003cli\u003eZhou Y, Hu J, Zhang H, Li X, Liu L. Pathophysiology of diabetes mellitus and its complications: the role of insulin resistance and beta-cell dysfunction. Diabetes Metab Syndr Obes. 2020; 13:451\u0026ndash;60.\u003c/li\u003e\n\u003cli\u003eGaltier F. Definition, epidemiology, risk factors. Diabetes Metab. 2010;36(6 Pt 2):628\u0026ndash;51. PMID: 21163426. \u003c/li\u003e\n\u003cli\u003eAtkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014;383(9911):69\u0026ndash;82. \u003c/li\u003e\n\u003cli\u003eLeslie RD. Predicting adult-onset autoimmune diabetes: clarity from complexity. Diabetes. 2010;59(2):330\u0026ndash;1.\u003c/li\u003e\n\u003cli\u003eSilva M, Barbosa K, Pereira J, Bento P, Godoy G, Gomes D. Prevalence of oral mucosal lesions among patients with diabetes mellitus types 1 and 2. An Bras Dermatol. 2015;90(1):49\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eAu CB, Smith GP. Recurrent aphthous stomatitis: A comprehensive review and recommendations on therapeutic options. Dermatol Ther. 2022;35(6): e15500. \u003c/li\u003e\n\u003cli\u003ePatil S, Reddy SN, Maheshwari S, Khandelwal S, Doni B, Sandhu S. Prevalence and comparison of recurrent aphthous stomatitis in different socio-economic groups and its impact on quality of life: a cross-sectional study. J Clin Diagn Res. 2017;11(12): ZC06\u0026ndash;ZC09. \u003c/li\u003e\n\u003cli\u003eBastos AdS, Leite ARP, Spin-Neto R, Nassar PcO, Massucato EMS, Orrico SRP. Diabetes mellitus and oral mucosa alterations: prevalence and risk factors. Diabetes Res Clin Pract. 2011;92(1):100\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eYuan Y, Ma X, Liu Y, et al. Emerging insights into the immunopathogenesis of recurrent aphthous stomatitis: a review. Clin Oral Investig. 2023;27(4):1093\u0026ndash;1101. \u003c/li\u003e\n\u003cli\u003eKarobari MI, Selvaraj S, Adil AH, Marya A. Modifiable and non-modifiable risk factors affecting oral and periodontal health and quality of life in South Asia. Open Dent J. 2022; 16: e2209270. \u003c/li\u003e\n\u003cli\u003eKathayat G, Selvido DI, Skallevold HE, Rokaya MB, Bhattarai BP, Marya A, et al. Natural oral care and herbal products for oral diseases and oral hygiene maintenance. In: Chauhan DN, Singh PR, Chauhan NS, Shah K, editors. Herbal Medicines: Recent Trends and Developments. Hoboken (NJ): Wiley; 2023. Chapter 3. \u003c/li\u003e\n\u003cli\u003eKhan S, Abbas S, Ali Z, et al. Association of oral manifestations with undiagnosed diabetes and prediabetes. J Pak Med Assoc. 2023;73(3):590\u0026ndash;594. \u003c/li\u003e\n\u003cli\u003eSato K, Miura H, Arai K. Glycemic control thresholds and their relationship with oral complications in patients with type 2 diabetes: a cross-sectional study. BMC Oral Health. 2022; 22:467. \u003c/li\u003e\n\u003cli\u003eAmerican Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes\u0026mdash;2022. Diabetes Care. 2022;45(Suppl 1): S17\u0026ndash;S38.\u003c/li\u003e\n\u003cli\u003eAhmed W, Smith R, Wilson G. Prevalence of oral mucosal lesions in diabetic patients. J Dent Res. 2023;102(2):221\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eTrentin M, Verardi G, Ferreira MDC, Carli Jd, Silva Sd, Lima I, et al. Most frequent oral lesions in patients with type 2 diabetes mellitus. J Contemp Dent Pract. 2017;18(2):107\u0026ndash;11. doi:10.5005/jp-journals-10024-2004.\u003c/li\u003e\n\u003cli\u003eSaini R, Al-Maweri S, Saini D, Ismail N, Ismail A. Oral mucosal lesions in non-oral habit diabetic patients and association of diabetes mellitus with oral precancerous lesions. Diabetes Res Clin Pract. 2010;89(3):320\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eMishra S, Shukla A, Yadav P, Tiwari P, Chaturvedi P. A comparative study on oral mucosal lesions among type 2 diabetes mellitus patients and non-diabetics. Asian J Pharm Clin Res. 2024;17(1):148\u0026ndash;52.\u003c/li\u003e\n\u003cli\u003eAl-Maweri SAA, Ismail NM, Ismail AR, Al-Ghashm A. Prevalence of oral mucosal lesions in patients with type 2 diabetes attending Hospital Universiti Sains Malaysia. Malays J Med Sci. 2013;20(4):39\u0026ndash;46.\u003c/li\u003e\n\u003cli\u003eBajaj S, Prasad S, Gupta A, Singh V. Oral manifestations in type-2 diabetes and related complications. Indian J Endocrinol Metab. 2012;16(5):777\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eAl-Maweri SAA, Ismail NM, Ismail AR, Al-Ghashm A. Prevalence of oral mucosal lesions in patients with type 2 diabetes attending Hospital Universiti Sains Malaysia. Malays J Med Sci. 2019;26(2):43\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eDjebabli N, Chelly W, Chaaben A, Bouguila J, Soua M, Ghedira H, et al. Oral lichen planus and diabetes mellitus: prevalence and clinical features (Tunisian experience). Int J Frontline Res Life Sci. 2022;1(1):1\u0026ndash;8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"high blood sugar level, oral aphthous lesions, recurrent aphthous stomatitis, FBS, HbA1c","lastPublishedDoi":"10.21203/rs.3.rs-7288666/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7288666/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntrodution:\u003c/h2\u003e\u003cp\u003eDiabetes mellitus, a systemic metabolic disorder, has been associated with various oral mucosal conditions, including recurrent aphthous stomatitis (RAS). This study aimed to assess the relationship between fasting blood sugar (FBS) and hemoglobin A1c (HbA1c) levels in patients with RAS compared to healthy individuals.\u003c/p\u003e\u003ch2\u003eMaterials and methods\u003c/h2\u003e\u003cp\u003eThis cross-sectional study included 60 participants: 30 patients with RAS (\u0026ge;\u0026thinsp;3 recurrences per year) and 30 age- and sex-matched controls with no history of aphthous lesions. After obtaining informed consent, fasting blood samples were collected to measure FBS and HbA1c levels. Patients with systemic diseases were excluded. Statistical analyses were performed using SPSS version 18, including independent t-tests, Mann\u0026ndash;Whitney U tests, and Spearman\u0026rsquo;s correlation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe results showed that the mean HbA1c level was significantly higher in the RAS group (5.36%) compared to the control group (4.87%) (P\u0026thinsp;=\u0026thinsp;0.002), and the mean FBS level was also significantly higher in the RAS group (95.93 mg/dL vs. 85.90 mg/dL; P\u0026thinsp;=\u0026thinsp;0.015). No significant difference in age or gender was observed between the two groups. Additionally, no significant association was found between the frequency of aphthous lesion recurrence and FBS or HbA1c levels (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study found that higher levels of fasting blood sugar and hemoglobin A1c were linked to an increased likelihood of developing oral aphthous lesions. In contrast, no significant correlation was observed between these glycemic markers and the frequency of lesion occurrence. Furthermore, gender did not show a significant influence on FBS or HbA1c levels.\u003c/p\u003e","manuscriptTitle":"Evaluation of the Relationship Between Fasting Blood Sugar (FBS) and HbA1c Levels and Recurrent Aphthous Lesions: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-15 06:31:14","doi":"10.21203/rs.3.rs-7288666/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"769f6563-917a-4f82-9129-df4c12bf6e87","owner":[],"postedDate":"September 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T13:41:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-15 06:31:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7288666","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7288666","identity":"rs-7288666","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}