Impact of Chronic Periodontitis on Levels of Glucoregulatory Biomarkers in Gingival Crevicular Fluid of Adults with and without Type 2 Diabetes

Abstract

The relationship between diabetes and periodontal disease is bidirectional, but information about the effect of chronic periodontitis on the levels of the glucoregulatory biomarkers locally in gingival crevicular fluid (GCF) is limited. The aim of this study was to compare the levels of 10 glucoregulatory biomarkers in GCF, firstly in subjects with type 2 diabetes (T2DM) presenting with and without chronic periodontitis and secondly, in subjects without diabetes, with and without chronic periodontitis. The material comprised a total of 152 subjects, stratified as: 54 with T2DM and chronic periodontitis (G1), 24 with T2DM (G2), 30 with chronic periodontitis (G3) and 44 without T2DM or periodontitis (G4). The levels of the biomarkers were measured using multiplex biometric immunoassays. Periodontal pocket depths were recorded in mm. Subsets G1 and G2 and subsets G3 and G4 were compared independently. Among T2DM subjects, GIP, GLP-1 and glucagon were significantly up-regulated in G1 compared to G2. Moreover, there were no statistical differences between the two groups regarding C-peptide, insulin, ghrelin, leptin and PAI-1. Comparisons among individuals without T2DM revealed significantly lower amounts of C-peptide and ghrelin in G3 than in G4. The number of sites with pocket depth ≥ 4mm correlated negatively with C-peptide (Spearman’s correlation co-efficient: -0.240, P < 0.01) and positively with GIP and visfatin (Spearman’s correlation co-efficient: 0.255 and 0.241, respectively, P < 0.01). The results demonstrate that chronic periodontitis adversely influences the GCF levels of glucoregulatory biomarkers, as it is associated with disturbed levels of biomarkers related to the onset of T2DM and its medical complications.

Salivary, gingival crevicular fluid and serum levels of ghrelin and chemerin in patients with periodontitis and overweight

“…in individuals without diabetes type 2. In that study the BMI was not reported . In serum no statistically significant difference was found, which is in contrast to the findings by Yilmaz et al .…”

“…Interestingly, elevated total and acylated ghrelin levels were found in the serum of patients with chronic periodontitis . Furthermore, the levels of ghrelin in gingival crevicular fluid were higher in patients with periodontitis and type 2 diabetes compared with periodontally healthy controls with type 2 diabetes, but lower in patients with periodontitis than in periodontally healthy controls when diabetes was absent …”

“…17 Furthermore, the levels of ghrelin in gingival crevicular fluid were higher in patients with periodontitis and type 2 diabetes compared with periodontally healthy controls with type 2 diabetes, but lower in patients with periodontitis than in periodontally healthy controls when diabetes was absent. 18 Chemerin, which belongs structurally to the cathelicidin/cystatin family, is present at high levels in the epithelium. 19 It has been identified as an adipokine involved in adipogenesis.…”

An update on the evidence for pathogenic mechanisms that may link periodontitis and diabetes

“…Mohamed et al. () found that gastric inhibitory polypeptide (GIP), glucagon‐like peptide‐1 (GLP‐1) and glucagon were significantly upregulated in diabetic patients with chronic periodontitis compared with diabetes patients only. The same study found that the number of sites with pocket depth >4 mm correlated positively with GIP.…”

Visfatin levels in gingival crevicular fluid and serum before and after non-surgical treatment for periodontal diseases

“…Mohamed et al reported a positive correlation between PD and GCF visfatin levels (34). Visfatin levels were also increased in the saliva following periodontal inflammation (35,36).…”