Association between periodontitis and diabetes

Background + Aims

• Diabetes poses a significant public health burden globally, with prevalence expected to rise sharply, especially in urbanizing areas of developing countries.
• Urbanization has been linked to lifestyle changes such as poor diet, reduced physical activity, and increased stress, contributing to higher diabetes rates.
• In Sri Lanka, diabetes prevalence ranges from 10-14%, with urban populations showing nearly double the prevalence of rural areas.
• Periodontitis, a known complication of diabetes, is well-documented but remains underexplored in Sri Lankans.
• This study aims to assess the prevalence of periodontitis in urban Sri Lankans with type 2 diabetes mellitus (T2DM) compared to those without diabetes.

Materials + Methods

• This cross-sectional study compared the periodontal status of urban Sri Lankans with T2DM to matched non-diabetic controls.
• Participants with T2DM were recruited from a clinical database, while age- and sex-matched controls were recruited locally. Controls were screened for diabetes and excluded if abnormal glucose levels (glycated haemoglobin (HbA1c) > 6.1% and fasting blood glucose (FBG) was >100mg/dl) were detected.
• Exclusions included edentulous individuals and those with systemic conditions affecting periodontal health.
• Demographic, clinical, and diabetes-related data, including HbA1c levels and glycaemic control, were collected. Controls were screened for diabetes and excluded if abnormal glucose levels were detected.
• Comprehensive periodontal examinations assessed probing depth (PD), gingival recession (GR), clinical attachment levels (CAL), and bleeding on probing (BOP).
• Periodontal status was classified into the following:
  • Periodontal health – no PD ≥3mm, BOP <15%
  • Gingivitis – BOP >15% and no PD >4mm
  • Chronic periodontitis – ≥6 sites with PD ≥5mm
• A power calculation estimated 271 diabetic, and 50 control participants needed.
• Statistical tests included chi-square for categorical data, ANOVA for parametric data, and Kruskal-Wallis/Mann-Whitney for non-parametric data, with adjustments to control Type I errors.

Results

• A total of 357 adults (173 males, 184 females) were recruited, including 285 with T2DM and 72 non-diabetic controls. 12 of the 72 controls were excluded due to impaired glucose levels.
• Of the T2DM group, 206 were categorized based on glycaemic control: good (54.3%), moderate (25.7%), and poor (19.9%).
• The groups were well-matched for age, gender, smoking status (>70% of all subjects had never smoked) and BMI. Blood pressure was significantly higher amongst the controls compared to the T2DM group, and significantly higher amongst the controls versus the well-controlled T2DM group.
• Chronic periodontitis was more common, although not statistically significant, in T2DM subjects (33.3%) compared to controls (21.7%, p=0.077).
• T2DM patients had significantly higher recession and BOP scores, with those in both good and poor glycaemic control groups showing more sites with PD ≥4 mm compared to controls. No significant differences were observed in missing teeth, but there was a trend toward more attachment loss in diabetic patients (p=0.07).
• Further analysis revealed no significant differences in diabetes care between T2DM patients with periodontal health/gingivitis versus periodontitis. However, within the non-diabetic group, periodontitis was associated with higher HbA1c values.
• Multiple regression analysis identified periodontal status as a predictor of HbA1c in non-diabetic patients, but not in T2DM patients.

Limitations