Abstract
This study assessed the periodontal conditions of type 2 diabetes (T2DM) patients attending an Outpatient Center in North Italy and explored the associations between metabolic control and periodontitis. Periodontal health of 104 T2DM patients (61 men and 43 women, mean age of 65.3 ± 10.1 years) was assessed according to CDC/AAP periodontitis case definitions and Periodontal Inflamed Surface Area (PISA) Index. Data on sociodemographic factors, lifestyle behaviors, laboratory tests, and glycated hemoglobin (HbA1c) levels were collected by interview and medical records. Poor glycemic control (HbA1c ≥ 7%), family history of T2DM, and C-reactive protein levels were predictors of severe periodontitis. An increase in HbA1c of 1% was associated with a rise in PISA of 89.6 mm2. On the other hand, predictors of poor glycemic control were severe periodontitis, waist circumference, unbalanced diet, and sedentary lifestyle. A rise in PISA of 10 mm2 increased the odds of having HbA1c ≥ 7% by 2%. There is a strong bidirectional connection between periodontitis and poor glycemic control. The inflammatory burden posed by periodontitis represents the strongest predictor of poor glycemic control.
Highlights
The prevalence of diabetes mellitus (DM) is increasing worldwide to epidemic proportions: 415 million people suffer from DM and the number is expected to rise to 642 millions by 2040 [1]
Patients with an established diagnosis of T2DM according to World Health Organization criteria [27] were consecutively recruited from among those who came for regular check-ups at the Outpatient Diabetes Center, Turin (Italy) from March 2018 to July 2019
In spite of the large number of studies investigating this latter aspect, only a few of them focused on the impact of the inflammatory burden of periodontitis assessed using the Periodontal Inflamed Surface Area (PISA) Index and none referred to the Control and Prevention/American Academy of Periodontology (CDC/AAP) periodontitis case definition [18,19,20]
Summary
The prevalence of diabetes mellitus (DM) is increasing worldwide to epidemic proportions: 415 million people suffer from DM and the number is expected to rise to 642 millions by 2040 [1]. DM has two major types: Type 1 (T1DM), characterized by failure to produce insulin, and type 2 (T2DM), in which both insulin resistance and relative insulin deficiency occur. T2DM is the most prevalent form of the disease, accounting for more than 90% of diabetic patients [2]. DM presents a serious challenge to the healthcare system since its complications are the leading causes of morbidity and mortality. According to the World Health Organization, it will be the seventh major cause of death in 2030 [3]. Systemic subclinical inflammation has been proposed as the underlying biological mechanisms of its chronic complications, such as micro vascular and nerve damage [4], with evidence of a strong association between levels of hemoglobin A1c (HbA1c) and risk of complications [5]
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