Mechanisms linking periodontitis and diabetes

Background + Aims

• Periodontitis and Type 2 Diabetes Mellitus (T2DM) are chronic inflammatory conditions that are closely interlinked. Diabetes exacerbates periodontal tissue damage, while periodontitis increases systemic inflammation, potentially worsening glycaemic management.
• Both conditions contribute to the ‘oral inflammatory burden’, measurable through markers in saliva. Beta-glucuronidase (bG), an enzyme reflecting neutrophil activity, and interleukin-1β (IL-1β), a pro-inflammatory cytokine, are key biomarkers.
• This study aimed to determine the strength of association between T2DM, periodontal status, and the levels of these biomarkers in saliva.
• The researchers hypothesised that both T2DM and periodontitis independently contribute to elevated salivary inflammatory markers, with periodontal disease having a stronger association.

Materials + Methods

• A cross-sectional study of 192 participants categorised into 6 groups based on diabetes status (T2DM or non-diabetic) and periodontal health (edentulous, mild/moderate periodontitis, severe periodontitis).
• Participant were excluded if they:
  • Had recent dental treatments (periodontal surgeries)
  • Had been taking NSAID or antibiotics in the last 6 months
  • Were pregnant
  • Had oral mucosal lesions.
• Saliva samples were collected and analysed for bG and IL-1β concentrations.
• Biomarker Analysis:
  • bG was measured using a fluorometric array.
  • IL-1β was quantified through enzyme-linked immunosorbent assay (ELISA)
• Data Analysis:
  • Statistical models assessed the relationship between periodontal severity, diabetes status, and biomarker levels.
  • Adjustments were made for confounding factors, such as age and systemic health conditions.
• Primary Outcome: Evaluate the relative contribution of diabetes and periodontitis to salivary bG and IL-1β concentrations.

Results

• Both T2DM and periodontitis independently contributed to increased oral inflammation as reflected by higher salivary bG levels.
• Periodontitis had a significantly stronger impact on bG levels compared to diabetes, with severe periodontitis associated with an estimated coefficient increase of  0.75 versus 0.41 units for diabetes.
• IL-1β concentrations were primarily influenced by periodontal severity and not diabetes status.
• Edentulous individuals exhibited the lowest levels of both biomarkers, highlighting the role of dental tissues in systemic inflammation.

Limitations