Introduction
Dermatoglyphics (Fingerprints) refers to the study of all features of ridged skin.1
Cummins and Midlo first formulated this term in 1943, derived from the Greek words "dermato" which means skin and "glyphics" means carvings.2
The ridged skin (also known as the friction ridges skin) is located on the digit and palmar surface of the hands (known as fingerprints and palm prints) and on the plantar surface and the toe of the feet. It is believed that the mechanical function of these ridges conveys a firmer grip and prevents slippage3 and is also believed to enhance the sense of touch.4
Diabetes is a serious and chronic disease that occurs, either when the pancreas cannot produce enough insulin, or when the body cannot use insulin effectively.5
It is characterized by high levels of glucose in the blood, which may lead to progressive damage in most tissues and organs of the body such as heart, blood vessels, eyes, kidneys, skin, and nerves. According to the international Diabetes Federation, in 2017 there were 425 million people with diabetes, and there are expected to be more than 629 million patients by 2045.6
There are two types of diabetes mellitus; type 1 and type 2 (formerly known as insulin and non-insulin diabetes mellitus). The most common type of diabetes is type 2 diabetes (T2 DM) whcih accounts for almost 90% of diabetics. It was previously called non-insulin-dependent or adult-onset diabetes. Symptoms of T2 DM are often less obvious or absent. Therefore, the disease may not be diagnosed for several years, until the complications appear.6
Early diagnosis and treatment are very important to prevent long-term complications of the disease like retinopathy, neuropathy, and nephropathy. The prediction of people with high risk of developing T2 DM is useful not only for disease prevention, but also to prevent the disease complications.
Dermatoglyphics as a diagnostic aid is now well established in number of diseases which have strong hereditary basis and is employed as a method for screening for abnormalities.7
Apart from its use in predicting the diagnosis of genetic disease; dermatoglyphics is also used in forensic medicine in individual identification, physical anthropology, human genetics and medicine. Sir Galton Francis (1892) published a book “finger prints”, which included the first classification of finger prints. He used ridge characteristics called ‘minutea’, still called Galton’s details.8
Materials and Methods
This was a prospective observational study carried out over a period of one year from March 2019 to February 2020 in the department of Forensic Medicine and Toxicology at Maheshwara Medical College, Patancheru, Hyderabad, Telangana.
A total of hundred known cases of type 2 diabetes mellitus were selected by simple random sampling who visited the OPDs. Also hundred normal healthy non diabetic individuals were taken as control cases. There were no ethical issues involved in the study. Informed consent was obtained from all the participants included in the study.
Methodology
A questionnaire was prepared for collection of data such as patient demographics which included age, history of present illness, past history, family history, personal history, any addictions such as smoking and alcohol.
Total of 100 participants were selected randomly as per above criteria
They were divided into n=50cases (with diabetes) and n=50 controls (with normal blood sugar levels) out of which half were males and half were females, their age distribution ranges from 31 to 70 years. All participants were explained about the procedure in detail. The patterns on both palms were recorded by the Modified Ink Method elucidated by Purvis Smith (1969).
Participants were asked to cleaned the hands with soap and water and then dried. Ink was placed on the ink slab and spread. The whole of the palm and fingers were smeared with ink by using the roller with light uniform strokes starting from the distal wrist crease to the finger tips, making sure the flexion creases, the ulnar margin, the central hollow of the palm and the finger tips are not devoid of ink. After inking, the palm was brought to the paper kept on the cylinder. The hand was rolled starting from the wrist and moving to the fingers with gentle pressure applied from the dorsal side by the operator. The individual fingertips were rolled from ulnar to radial side to obtain rolled finger prints. The procedure was repeated for the other hand.
Soon after the print was taken, it was examined for clarity in the different fingers and the palmar areas. The ink from hands was easily removed with water.
The data was entered and the printed sheets had name, age and gender for cases and controls. The prints were then subjected for detailed dermatoglyphic analysis with the help of magnifying hand lens and ridge counting was done with the help of a sharp needle. The details were noted on the same paper with pencil pen. The palmar prints were analyzed qualitatively and quantitatively.
The impressions were analyzed for finger and palmar qualitative and quantitative features. Quantitative dermatoglyphic parameters studied were individual finger ridge count for ten fingers, pattern intensity, total finger ridge count (TFRC), absolute finger ridge count (AFRC), in the fingertips, and a-b count, Atd angle.
Observations and Results
Table 1
Age and gender distribution of cases and controls
|
Age distribution (in years) |
Males |
Females |
|
30-40 |
08 |
08 |
|
41-50 |
10 |
10 |
|
51-60 |
20 |
20 |
|
61-70 |
12 |
12 |
|
Total |
50 |
50 |
Table 2
Fingertip pattern configurations in males
In the present study it was observed that there was an increase in the frequency of whorls in both the hands in the cases when compared to controls. Whorls constituted 28 (56%) in the cases and 21 (42%) in controls of right hand. Whorls constituted 29 (58%) in the cases and 14 (28%) in the controls of left hand.
There was decrease in the loops in both hands in the cases when compared to controls.
Table 3
Fingertip pattern in females
In females, there was an increase in the frequency of whorls in both the hands in the cases when compared to controls. Whorls constituted 23 (46%) in the cases and 19 (38%) in controls of right hand. Whorls constituted 26 (52%) in the cases and 16 (32%) in the controls of left hand.
There was decrease in loops in both the hands in the cases when compared to controls. Loops constituted 21 (42%) in the cases and 23 (46%) in controls of right hand. Loops constituted 17 (34%) in the cases and 26 (52%) in the controls of left hand.
Males had significant reduction in arches in the right hand in comparison to females.
Palmar pattern configuration and Finger ridge count and Atd angle in diabetic population and non diabetic population
In the present study average of total finger ridge count measured in males was 72.6 in right hand, 73.6 in left hand and was increased when compared to male non-diabetics, where the average total finger ridge count was 66.0 on right hand and 68.1 on left hand. In the present study, average of total finger ridge count in females was 71.7 in right hand, 74.5 in left hand which was more as compared to non-diabetics females, which showed an average total finger ridge count of 65.0 on right hand and 66.1 on left hand.
Palmar a-b Ridge Counts
In the present study, the average a-b ridge count of diabetic patients in males was 35 on right hand, 36 on left hand in males and compared to non-diabetic males counted 33 on right hand and 36 on left hand. The average a-b ridge count of diabetic patients in females was 35 on right hand, 36 on left hand which was decreased when compared to females 36 on right hand, 37 on left hand.
Palmar Atd angle
In the present study, atd angle was wider in male diabetic patients ie, 37.8° on right hand, 37.5° on left hand and and when compared to non-diabetic males it was 36.6° on right hand, 36.5°on left hand. The atd angle in females had 36.4° on right hand, 36.9° on left hand when compared to non-diabetic (control) females, where it was 37.4° on right hand and 37.5° on left hand.
Discussion
Comparative studies related to Finger Pattern configuration
In the present study, there was an increase in the frequency of whorls and decrease in loops when compared to controls. Srivastava et al9 observed similar findings in their study where they noted higher incidence of spiral whorls in both hands of male and female cases and a higher frequency of loops in both hands of controls. In a similar study done by Rakate NS et al10 they too observed an increase in the number of whorls of both hands in males and females as compared with control group, while the frequency of ulnar loop was more in control group than diabetic patients. In the study by Sumangaladevi et al11 ulnar loops showed maximum percentage frequency in both right and left hands of female patients and controls. Ulnar loops showed maximum percentage frequency in both right and left hands of male normal controls, whereas, whorls showed maximum percentage frequency in right and left hands of male patients.
Comparative studies related to the Total Finger Ridge Counts (TFRC)
In the present study, average of total finger ridge count measured in diabetic males was increased when compared to male non-diabetics and it correlates well with the studies of Rakate NS et al10 and Srivatsava et al. While Rakate NS et al 10 study showed average of total finger ridge count measured in males more when compared to non-diabetic population and Srivatsava et al 9 observed the fingertip ridge counts to be higher in cases as compared to controls and Sumangaladevi et al study11 observed the TFRC was high in normal females and decreased in patients. Panda et al (2004); Ravindranath et al (1995) showed increase in ulnar loop patterns in both sexes in diabetics but Sant et al (1983) showed decrease in ulnar loop in both sexes. Nayak et al (2015) showed no significant difference in the diabetics and control.
Comparative studies related to a-b ridge count
In the present study, the average a-b ridge count of diabetic patients in males was 35 on right hand, 36 on left hand in males and compared to non-diabetic males counted 33 on right hand and 36 on left hand. The average a-b ridge count of diabetic patients in females was 35 on right hand, 36 on left hand which was decreased when compared to control females 36 on right hand and 37 on left hand. In the study by Sudagar M et al 12 the maximum percentage of a-b ridge count was seen between 31-35 (34.6%) in diabetic males as compared to control males where it was seen between 36-40 (34.6%). The maximum percentage of a-b ridge count was seen between 31-35 (36%) in diabetic females as compared to control females where it was seen between 36-40 (35.3%).
Bala et al13 showed higher mean a b ridge count in diabetics than control and highly significant in females. Similar findings were recorded by Oladipo and Ogunnowo.14 A study done by Perumal and Manjunath15 showed statistically significant decreased levels of mean right a-b and left a-b ridge count were observed in male Type 2 diabetes mellitus patients compared to normal male subjects and also decreased levels of mean right b-c, left c-d ridge counts in male Type 2 diabetes mellitus patients compared to normal male subjects but these values were statistically insignificant.
Sumangaladevi et al11 also noted a-b ridge count to be decreased in female patients when compared to normal controls.
Rakate NS et al10 reported the average a-b ridge count of diabetic patients as 36.00 on right hand, 37.00 on left hand in males and in females it was 34.66 on right hand and 35.33 on left hand which was more as compared to non-diabetic males which counted 34.42 on right hand and 35.44 on left hand; and in females it was 35.85 on right hand and 36.78 on leftt hand. Srivatsava et al9 did not observe any significant difference in the scores between the cases and controls for these parameters for male and female subjects.
Comparative studies related to Atd angle
In the present study, the Atd angle was wider in male diabetic patients ie, 37.8° on right hand, 37.5° on left hand and when compared to non-diabetic males it was 36.6° on right hand, 36.5°on left hand. The Atd angle in females had 36.4° on right hand and 36.9° on left hand when compared to non diabetic (control) females where it was 37.4° on right hand and 37.5° on left hand.
Sudagar M et al12 observed maximum percentage of Atd angle to be between 360-400 (49.3% and 46%) in both diabetic and control males but percentage-wise it differed. The maximum percentage of Atd angle was seen between 360-400 (42%) in diabetic females as compared to control females where it was seen between 410-450 (39%). In Rakate NS et al10 study, the Atd angle was wider in diabetic male patients and was 37.98° on right hand and 38.34° on left hand. In females, it was 36.41° on right hand and 36.95° on left hand compared with non-diabetic where it was 37.98° on right hand, 39°on left hand and in females it was 36.41° on right hand and 36.95° on left hand. Srivatsava et al 9 observed no significant difference in the scores between the cases and controls for these parameters for male and female subjects regarding Atd angle. Zieglar et al16 16 reported that there appear to be little agreement between the findings of various authors. Possible reasons are due to the small sample sizes chosen, incomplete diagnoses, control group inadequacy, statistical errors, and lack of open- mindedness in subjects.
Conclusion
Dermatoglyphics is a noninvasive simple technique and can be used as an initial screening method to identify diabetic population. In the present study there is increased number of whorl, decreased number of loops and arches in type 2 diabetes mellitus patients.
Dermatoglyphic investigation is absolutely cost effective and requires no hospitalization and it can help in predicting the phenotype of possible future illness. It can be used as a screening tool for early identification of at-risk individuals and prevent the further complications. Several studies done in different population have identified significant correlation between different fingerprint patterns and diabetes. However the type of pattern identified varies from one region to another. This may be because of racial dermatoglyphic differences from one population to the other.
