Impact of periodontal treatment on diabetes management

Background + Aims

• Diabetes mellitus (DM), particularly type 2 (T2DM), is prevalent in the elderly and associated with complications like neuropathy, retinopathy, and cardiovascular issues. Poor glycaemic management exacerbates these complications, significantly affecting quality of life.
• Periodontitis, a chronic inflammatory disease of the gums, is common in individuals with T2DM. Research indicates a two-way relationship: Periodontitis worsens gum health, while DM elevates systemic inflammation, impairing blood glucose control.
• In Japan, over half the population aged 40+ years experiences periodontitis. Addressing periodontitis could potentially improve glycaemic management in people with T2DM.
• This study aimed to assess whether dental visits for periodontal treatment correlate with improved diabetes outcomes in an elderly Japanese cohort.

Materials + Methods

• A cross-sectional study involving 14,551 individuals aged 75 or 80 years in Japan. Data were obtained from health exams and dental claims records.
• Participants were categorised based on dental visit status:
  • No visits
  • Periodontal treatment – The frequency of periodontal treatment was also assessed (0, 1–4, or ≥5 days).
  • Other dental treatments
• Diabetes was defined by standard criteria, including fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5%. Prediabetes was defined as fasting glucose ≥100 mg/dL or HbA1c ≥5.7%.
• Data collection included:
  • Health exam results (e.g., BMI, fasting glucose, HbA1c).
  • Self-reported lifestyle factors such as exercise, diet, and smoking.
• Statistical analyses (multivariate regression models) adjusted for confounders like age, sex, BMI, physical activity, and smoking habits.
• The primary outcome was the association between dental visits for periodontal treatment and glycaemic management (HbA1c levels and diabetes status).

Results

• The prevalence of type 2 diabetes mellitus (T2DM) was 14.2%, with a higher proportion in men (18%) compared to women (11.4%). 
• Several variables, including sex, smoking habits, weight gain, BMI, physical activity, eating speed, and dental visit frequency, were significantly associated with diabetes status.
• Participants with T2DM were less likely to have received periodontal treatment compared to those without diabetes or those with prediabetes. 
• Individuals with T2DM had fewer days of periodontal treatment than other groups. 
• Multivariate logistic regression analyses showed that individuals who visited a dental clinic or received periodontal treatment had significantly lower odds of T2DM compared to those who did not attend dental visits. However, no significant association was found for other types of dental treatment. 
• Subjects who underwent periodontal treatment showed:
  • Reduced odds of having T2DM (adjusted odds ratio: 0.74)
  • A small but significant reduction in HbA1c levels (p < 0.05).
• There was no significant relationship between dental visits and prediabetes status. 
• Further multivariate linear regression analysis demonstrated that receiving periodontal treatment was significantly associated with lower HbA1c levels, indicating better glycaemic control.
• Regular periodontal treatment, even for ≥5 days annually, was linked to better glycaemic management in elderly individuals.
• The results suggest that regular periodontal treatment may play a protective role against developing T2DM and help in maintaining better metabolic health.

Limitations