Abstract
INTRODUCTION AND AIMS: Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder influenced by internal metabolic disruptions and external exposures, known as exposomes, which increase disease risk. Identifying salivary metabolites is a promising method to detect biomarkers for both endogenous and environmental factors. This study utilised a dual approach to profile salivary endogenous metabolites and exposomes, aiming to provide a comprehensive understanding of T2DM by integrating biological and environmental factors, thereby improving biomarker discovery and risk prediction. METHODS: Salivary metabolites were analysed via ultraperformance liquid chromatography coupled with Q-Exactive mass spectrometry in samples from women with T2DM (n = 39) and healthy controls (n = 40). The groups were matched for age, sex, periodontitis, dyslipidaemia, and hypertension. The identified metabolites were mapped to the Human Metabolome Database and the Blood Exposome List using U.S. Environmental Protection Agency resources. RESULTS: Principal component analysis revealed distinct clusters for endogenous metabolites and exposomes, leading to separate analyses. In the endogenous metabolite category, 64.5% of the metabolites significantly differing between DM and non-DM groups were dipeptides (false discovery rate <0.05, variable importance for the projection >2). Among the dipeptides, Gln-Trp and Phe-Asn were identified as the top predictors of T2DM, with an area under the curve of 0.87, while His-Phe, His-Tyr, Met-Tyr, and Leu-Gln had area under the curve of 0.85. In the exposome category, univariate regression revealed significant associations between synthetic dipeptides and agrochemical exposomes and fasting plasma glucose levels, with daminozide exhibiting the greatest effect size. CONCLUSION: Leveraging saliva's noninvasive collection, these findings underscore the diagnostic potential of salivary dipeptides and emphasise the importance of addressing exposomes in T2DM management. CLINICAL RELEVANCE: By integrating endogenous and exposome profiling, this study offers a novel approach for identifying metabolic and environmental risk factors, advancing biomarker discovery and risk prediction to improve early diagnosis and personalised management of T2DM.