Background Treatment of diabetes includes oral antidiabetic drugs (OAD), insulin, or their combinations. Insulin can achieve faster glycemic control and have anabolic action on bone. This study was undertaken to assess the prevalence and severity of periodontitis, and to estimate the proportional relationship between periodontal inflamed surface area, clinical attachment loss, and glycated hemoglobin (HbA1c) level in patients with type 2 diabetes (T2DM) on OAD therapy and on insulin therapy. Methods This cross‐sectional study comprised 130 patients with T2DM on OAD therapy (OAD group) and 130 patients with T2DM on insulin therapy (INSULIN group). All patients were assessed for sociodemographic, behavioral characteristics, clinical history, periodontal parameters (bleeding on probing, probing depth, clinical attachment loss [Clinical AL], Oral Hygiene Index‐simplified, plaque index, and periodontal inflamed surface area [PISA]), and biochemical variables (HbA1c, fasting plasma glucose, postprandial plasma glucose). Results Prevalence, extent, and severity of periodontitis and PISA were lower in the INSULIN group as compared with the OAD group. A proportional relationship was observed between HbA1c and PISA and between HbA1c and Clinical AL. A unit increase in HbA1c is associated with an increase in PISA of 130.47 mm2 and an increase in Clinical AL of 0.182 mm. Conclusion A proportional relationship was observed between PISA, clinical attachment loss, and HbA1c level in patients with type 2 diabetes mellitus on insulin therapy and OAD therapy. Despite comparable oral hygiene status and glycemic control between the two groups, the periodontal parameters were lesser in the INSULIN group as compared with the OAD group.
A bidirectional inflammatory link exists between periodontitis and diabetes mellitus. Diabetes increases the prevalence and severity of periodontitis and periodontitis affects glycemic control. Treatment of diabetes is with oral antidiabetic drugs (OAD), insulin or their combinations. Insulin achieves faster glycemic control and has other beneficial effects. This study was undertaken to compare the prevalence, extent and severity of periodontal disease, to correlate periodontal inflamed surface area (PISA) with Glycated Hb (HbA1c) and to find the dose response relationship between PISA and HbAic in type 2 diabetes mellitus (T2DM) on insulin therapy and on OAD therapy. The study comprised of 130 T2DM patients on oral antidiabetic drugs therapy (OAD group) and 130 T2DM patients on insulin therapy (INSULIN group). All subjects were assessed for periodontal parameters (BOP, PPD, CAL, OHI-S Index, PI Index and PISA) and systemic parameters (HbA1c, FPG, PPG). The proportion of periodontitis was lower in INSULIN group (46.2%) as compared to OAD group (83.1%). Extent and severity of periodontitis and PISA were lower in INSULIN group as compared to OAD group. HbA1c was positively correlated with PISA in OAD group(r=0.391)(p <0.001) and in INSULIN group (r=0.492) (p <0.001). A dose response relationship between PISA and HbA1c has been observed and an increase in HbA1c of 1% is associated with an increase in PISA of 195mm2 (p <0.001). Multiple linear regression models showed that shifting from OAD to INSULIN results in the decrease of PISA by 605.4mm² (p <0.001). This indicates to the beneficial effects of insulin on periodontal tissues. Dose response relationship between HbA1c and PISA confirm the bidirectional relationship between diabetes mellitus and periodontal disease. Disclosure R.J. Vadakkekuttical: None. S. Pattayil: None. C. Radhakrishnan: None.
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