Periodontal Disease and NIDDM in Pima Indians

Nelson, Robert G.; Shlossman, Marc; Budding, Lynn M; Pettitt, David J.; Saad, Mohammed F.; Genco, Robert J.; Knowler, William C.

doi:10.2337/diacare.13.8.836

Cited by 346 publications

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“…These assumptions may not be valid when the exposure and the covariates vary over time, because a covariate may be affected by the exposure and also be a confounder. In the present analysis, the level of hyperglycemia may be a confounder because it is a known risk factor for kidney disease (20) and is associated with periodontitis (3,4,6). On the other hand, the level of glycemia also rises as a consequence of periodontitis (6,7).…”

Section: Conclusion -P E R I O D O N T I T I Smentioning

confidence: 93%

“…METHODS -Data were collected as part of a longitudinal study of diabetes and its complications in the Gila River Indian Community of Arizona (4). The diabetes study was initiated in 1965, and members of the community are invited to attend a research clinic for examination and screening every 2 years.…”

Section: Research Design Andmentioning

confidence: 99%

“…The most prevalent form is chronic periodontitis (1). Individuals with diabetes are at increased risk of developing periodontitis, and, once established, periodontitis is more severe in people with diabetes (3)(4)(5)(6). Poor glycemic control hastens the progression of periodontitis and, in turn, periodontitis appears to further impair glycemic control (6 -8).…”

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confidence: 99%

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Effect of Periodontitis on Overt Nephropathy and End-Stage Renal Disease in Type 2 Diabetes

et al. 2007

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OBJECTIVE -The purpose of this study was to investigate the effect of periodontitis on development of overt nephropathy, defined as macroalbuminuria, and end-stage renal disease (ESRD) in type 2 diabetes. RESEARCH DESIGN AND METHODS -Individuals residing in the Gila River IndianCommunity aged Ն25 years with type 2 diabetes, one or more periodontal examination, estimated glomerular filtration rate Ն60 ml/min per 1.73 m 2 , and no macroalbuminuria (urinary albumin-to-creatinine ratio Ն300 mg/g) were identified. Periodontitis was classified as none/ mild, moderate, severe, or edentulous using number of teeth and alveolar bone score. Subjects were followed to development of macroalbuminuria or ESRD, defined as onset of renal replacement therapy or death attributed to diabetic nephropathy.RESULTS -Of the 529 individuals, 107 (20%) had none/mild periodontitis, 200 (38%) had moderate periodontitis, 117 (22%) had severe periodontitis, and 105 (20%) were edentulous at baseline. During follow-up of up to 22 years, 193 individuals developed macroalbuminuria and 68 developed ESRD. Age-and sex-adjusted incidence of macroalbuminuria and ESRD increased with severity of periodontitis. After adjustment for age, sex, diabetes duration, BMI, and smoking in a proportional hazards model, the incidences of macroalbuminuria were 2.0, 2.1, and 2.6 times as high in individuals with moderate or severe periodontitis or those who were edentulous, respectively, compared with those with none/mild periodontitis (P ϭ 0.01). Incidences of ESRD in individuals with moderate or severe periodontitis or in those who were edentulous were 2.3, 3.5, and 4.9 times as high, respectively, compared with those with none/mild periodontitis (P ϭ 0.02).CONCLUSIONS -Periodontitis predicts development of overt nephropathy and ESRD in individuals with type 2 diabetes. Whether treatment of periodontitis will reduce the risk of diabetic kidney disease remains to be determined. Diabetes Care 30:306 -311, 2007P eriodontitis is a common infection of the periodontal tissues (1) and a major cause of tooth loss in adults (2,3). The most prevalent form is chronic periodontitis (1). Individuals with diabetes are at increased risk of developing periodontitis, and, once established, periodontitis is more severe in people with diabetes (3-6). Poor glycemic control hastens the progression of periodontitis and, in turn, periodontitis appears to further impair glycemic control (6 -8).Periodontitis predicts cardiovascular disease risk (9) and deaths from diabetic kidney disease and cardiovascular disease in individuals with type 2 diabetes (10). However, the relationship between periodontitis and diabetic kidney disease has not been fully explored. Among nonobese individuals with type 2 diabetes in Japan, IgG titers for Porphyromonas gingivalis (a periodontal pathogen) were correlated with the urinary albumin-to-creatinine ratio (ACR), although analyses were not adjusted for confounding factors (11). In the Atherosclerosis Risk in Communities (ARIC) Study, a largely nondiabetic p...

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Section: Conclusion -P E R I O D O N T I T I Smentioning

confidence: 93%

Section: Research Design Andmentioning

confidence: 99%

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Effect of Periodontitis on Overt Nephropathy and End-Stage Renal Disease in Type 2 Diabetes

et al. 2007

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“…Similar results were reported by a study on Pima Indians which showed type 2 diabetes was associated with severity of periodontitis independent of gender. 9 Genco et al reported that BMI positively correlated with the severity of periodontal attachment loss and this relationship is modulated by insulin resistance. 19 In present study, cases had significantly higher BMI score as compared to controls which could be an aggravating factor for diabetes as well as periodontitis.…”

Section: Methodsmentioning

confidence: 99%

Periodontal Disease as a Complication in Type 2 Diabetes Mellitus– A Hospital Based Study in Uttarakhand, India

Shah¹

2016

jmscr

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“…Diabetes mellitus is a complex disease with both metabolic and vascular components, and is characterized by hyperglycemia due to defects in insulin secretion or action or both. It is a systemic disease of the innate immune system 14) , and patients with DM are prone to severe periodontitis 11) , which is considered its sixth complication 8) . No significant differences were observed in the subgingival biofilm between periodontitis patients with or without DM 24) .…”

Section: Introductionmentioning

confidence: 99%

Clinical Case Report of Long-term Follow-up in Type-2 Diabetes Patient with Severe Chronic Periodontitis and Nifedipine-induced Gingival Overgrowth

Shibukawa

Fujinami

Yamashita

2012

Bull. Tokyo Dent. Coll.

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In this case report, we describe the clinical course over a 14-year follow-up in a 47-year-old diabetes patient with severe chronic periodontitis and nifedipine-induced gingival overgrowth. The patient had a history of hypertension for over 5 years and uncontrolled type 2 diabetes. Overgrown gingiva was observed in most of the teeth and was marked in the upper and lower anterior teeth. A probing pocket depth of ≥4 mm and bleeding on probing (BOP) were observed in 94 and 90% of sites examined, respectively. At baseline, his hemoglobin A1c (HbA1c) was 8.5%. The patient received periodontal and diabetic treatment simultaneously. Medication was changed from nifedipine chloride to an angiotensin-converting enzyme inhibitor. After initial therapy and subsequent periodontal surgery, gingival overgrowth disappeared and probing depth and BOP showed a significant improvement. No recurrence was observed during supportive periodontal therapy (SPT). The HbA1c level improved from 8.5 to 6.3% after periodontal treatment, subsequently remaining at a good level during SPT over 10 years. This study demonstrated that periodontal treatment, withdrawal of medication and control of diabetes can result in remarkable improvements in type 2 diabetes patients with chronic periodontitis and nifedipine-induced gingival overgrowth. These results suggest that comprehensive periodontal treatment in combination with treatment for diabetes mellitus can exert a positive influence on blood glucose levels and periodontal condition in diabetic patients.Key words: Chronic periodontitis -Nifedipine -Gingival overgrowthType 2 diabetes -Case report Case Report 91Bull Tokyo Dent Coll (2012) 53(2): 91-99

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Periodontal Disease and NIDDM in Pima Indians

Cited by 346 publications

References 0 publications

Effect of Periodontitis on Overt Nephropathy and End-Stage Renal Disease in Type 2 Diabetes

Effect of Periodontitis on Overt Nephropathy and End-Stage Renal Disease in Type 2 Diabetes

Periodontal Disease as a Complication in Type 2 Diabetes Mellitus– A Hospital Based Study in Uttarakhand, India

Clinical Case Report of Long-term Follow-up in Type-2 Diabetes Patient with Severe Chronic Periodontitis and Nifedipine-induced Gingival Overgrowth

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