Bidirectional Association between Metabolic Control in Type-2 Diabetes Mellitus and Periodontitis Inflammatory Burden: A Cross-Sectional Study in an Italian Population

Abstract

This study assessed the periodontal conditions of type 2 diabetes (T2DM) patients attending an Outpatient Center in North Italy and explored the associations between metabolic control and periodontitis. Periodontal health of 104 T2DM patients (61 men and 43 women, mean age of 65.3 ± 10.1 years) was assessed according to CDC/AAP periodontitis case definitions and Periodontal Inflamed Surface Area (PISA) Index. Data on sociodemographic factors, lifestyle behaviors, laboratory tests, and glycated hemoglobin (HbA1c) levels were collected by interview and medical records. Poor glycemic control (HbA1c ≥ 7%), family history of T2DM, and C-reactive protein levels were predictors of severe periodontitis. An increase in HbA1c of 1% was associated with a rise in PISA of 89.6 mm2. On the other hand, predictors of poor glycemic control were severe periodontitis, waist circumference, unbalanced diet, and sedentary lifestyle. A rise in PISA of 10 mm2 increased the odds of having HbA1c ≥ 7% by 2%. There is a strong bidirectional connection between periodontitis and poor glycemic control. The inflammatory burden posed by periodontitis represents the strongest predictor of poor glycemic control.

Actualización de la Relación Bidireccional de la Diabetes Mellitus y la Enfermedad Periodontal

“…El deficiente control glucémico en los pacientes diabéticos conduce a una respuesta inflamatoria desregulada, la cual involucra la actividad inmunitaria, la función de los neutrófilos y el patrón de citoquinas, promoviendo el daño del tejido conectivo y produciendo en muchos casos inflamación de las encías, destrucción del periodonto y migración patológica de los dientes, con la consiguiente generación de diastemas, además de presentar un mayor sangrado gingival, en contraste con los pacientes diabéticos controlados, independientemente de los porcentajes de placa bacteriana registrados (Nascimento et al, 2018;AL-Haddad et al, 2021;Romano et al, 2021). En ese sentido, se ha evidenciado también que el riesgo de padecer periodontitis aumenta 2 a 3 veces en perso-nas con diabetes en contraste con aquellas no padecen dicha enfermedad y que el nivel glucémico es determinante para establecer el riesgo (Asthana & Chhina, 2021;Rapone et al, 2021).…”

Novel Insight into the Mechanisms of the Bidirectional Relationship between Diabetes and Periodontitis

“…The increased risk of periodontitis in DM was first described by Löe in 1993, and periodontitis was found as the sixth complication of DM [ 18 ]. Since then several epidemiological studies have confirmed that patients with both type 1 and type 2 DM have a three- to fourfold increased risk of periodontitis and severity of periodontitis is much greater in uncontrolled DM [ 19 , 20 , 21 , 22 , 23 ]. Moreover, the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) added DM among the risk factors for the progression of periodontal disease [ 3 , 24 ] and recommend the use of HbA1c for periodontitis grading [ 3 ].…”

Incidence of Arterial Hypertension in People With Periodontitis and Characterization of the Oral and Subgingival Microbiome: A Study Protocol

“…The implementation of this classification improved reporting quality and permitted meaningful comparisons of the prevalence of periodontal diseases across populations in epidemiological studies (48). Indeed, many recent epidemiological studies with diverse populations in different parts of the world have used this classification (52)(53)(54)(55)(56)(57), as well as (58)(59)(60)(61) and (61)(62)(63).…”