Association between periodontitis and diabetes

Background + Aims

• Diabetes mellitus (DM) is a chronic condition marked by high blood glucose levels due to insufficient or inefficient insulin use. Poorly managed DM increases risks of cardiovascular and kidney diseases.
• Periodontitis, a severe gum disease causing tissue and bone damage, is more prevalent in people with diabetes. Both conditions share a bidirectional relationship, where each can worsen the other.
• Evidence suggests that well-managed diabetes may reduce the risk of periodontitis. However, the connection between pre-diabetes or well-controlled diabetes and periodontitis is unclear.
• Pre-diabetes is a state where blood glucose levels are higher than normal but not high enough for a diabetes diagnosis. It affects many individuals in Western countries, yet studies exploring its link to periodontitis are inconsistent or lack proper design.
• This study aimed to examine whether pre-diabetes or well-managed diabetes increases the risk of periodontitis, tooth loss, or edentulism using data from the large population-based SHIP-Trend study in Germany.

Materials + Methods

• The study was part of the Study of Health in Pomerania (SHIP)-Trend, a cross-sectional survey conducted in North-Eastern Germany.
• Participants included 3,086 adults aged 20–82 years, with data collected between 2008 and 2012.
• Periodontal health was assessed using measures like clinical attachment loss (CAL) and periodontal probing depth (PPD) through a half-mouth protocol. Tooth count and edentulism status were recorded.
• Glucose regulation categories:
  • Normal glucose tolerance (NGT).
  • Pre-diabetes (impaired fasting glucose or glucose tolerance).
  • Newly detected diabetes (HbA1c ≥7.0%).
  • Known diabetes, well-managed (HbA1c <7.0%).
  • Known diabetes, poorly managed (HbA1c ≥7.0%).
• Laboratory measures included fasting plasma glucose and oral glucose tolerance tests.
• Statistical analysis adjusted for confounders like age, BMI, smoking, and socioeconomic factors. Regression models evaluated associations between glucose regulation and periodontal outcomes.

Results

• No consistent association between pre-diabetes and periodontitis or tooth loss was found after adjusting for confounders.
• There was no significant increase in periodontitis or edentulism risk, when assessing well-controlled diabetes individuals, compared to individuals with normal glucose tolerance.
• Those with poorly-managed diabetes were associated with higher mean CAL and greater likelihood of tooth loss or edentulism.

Limitations