IDF21-0569 Periodontal disease is associated with increased risk of Diabetes and Pre-diabetes

Abstract

Background: Early diagnosis of diabetes mellitus and pre-diabetes is essential for the timely management of diabetes and its complications as well as the prevention of diabetes in individuals with pre-diabetes. Periodontal disease has also been recognized as the sixth complication of diabetes although this is still under-appreciated by endocrinologists or physicians in general. Since it has been suggested that severe periodontitis might be an early complication of diabetes, therefore periodontal disease may be a useful indicator to screen for the risk of diabetes or pre-diabetes in dental patients who otherwise do not know of their glycemic status. Aim: In this study, HbA1c levels and subsequently the prevalence of diabetes and pre-diabetes in participants with and without periodontitis of various stages were investigated. Method: From 88 mild periodontitis patients, 132 moderate periodontitis patients, 210 severe periodontitis patients and 66 patients without periodontitis (control), HbA1c values were obtained by a finger-prick blood sample taken from each participant which was then tested in a point-of-care HbA1c analyzer. Differences in mean HbA1c values and prevalence of diabetes and pre-diabetes between the different periodontitis and control groups were analyzed. Multivariate analyses were performed, correcting for known risk indicators for diabetes screening. Results: In this cohort of a total of 496 participants, 29(5.8%) and 154 (31.0%) patients were identified with HbA1c levels corresponding to the ADA guideline levels for diabetes (HbA1c > 6.5%) and pre-diabetes (HbA1c 5.7–6.4%), respectively. In addition, the mean HbA1c levels increases as the stage of periodontitis increases from no periodontitis to severe periodontitis. Periodontal disease of all stages have higher proportion of hyperglycaemia as compared to non-periodontitis(control) patients. However, it is the severe periodontitis group that showed a significantly higher percentage of patients with HbA1c values in the diabetes range as compared with the mild/moderate periodontitis group (p < 0.001). The prevalence of pre-diabetes was significantly higher in patients with moderate periodontitis compared with patients without periodontitis or with patients having mild periodontitis. In the severe periodontitis group, 18 (8.6%) patients had HbA1c levels in the diabetes range and 51 (24.3%) patients could be diagnosed with prediabetes according to the ADA-guidelines, whereas in the moderate periodontitis group, 59 (44.7%) subjects had HbA1c levels in the pre-diabetes range and only 2 (1.5%) of them reached HbA1c values for diabetes diagnosis. Discussion: Periodontitis is associated with increased levels of HbA1c and subsequently with an increased prevalence of those at risk for diabetes and pre-diabetes. We suggest that severe periodontal disease may be a useful risk indicator for early diabetes or pre-diabetes. This study also demonstrates the important role that dentists can play in the early referral of their patients who may already have undiagnosed diabetes and pre-diabetes to endocrinologist so as to receive timely medical diagnosis, prevent or delay progression from pre-diabetes to overt diabetes mellitus and intervention to prevent potential diabetes complications which in turn reduces disease burden.