Abstract
Asian Indians develop type 2 diabetes mellitus (T2DM) much earlier as compared to White Caucasians, due to unique phenotypic and genetic architecture. Periodontitis in T2DM patients is often a neglected clinical feature. This study was conducted to derive predictor variables for gingival index in middle-aged Asian Indians with T2DM in a semiurban population of Dravidian ethnicity from Tamil Nadu, India. T2DM patients (n = 232, mean age: 50.6 ± 10.4 years) with periodontitis (n = 123, mean age: 54.3 ± 2.4 years) and without periodontitis (n = 109, mean age: 55.2 ± 3.1 years) were recruited between 2014 and 2016 by purposive sampling method. Dental examinations for pocket depth (PD) and clinical attachment level (CAL) were performed and gingival index was calculated. Fasting venous blood samples were analysed for measures of glycaemia and cholesterol. Significant positive correlation (p < 0.01) was observed for gingival index with glycosylated haemoglobin (HbA1c), pocket depth, presence of T2DM, and clinical attachment level. Stepwise multiple linear regression analysis derived increased pocket depth (p < 0.01), elevated HbA1c (p < 0.01), clinical attachment level (p < 0.01), and presence of diabetes (p < 0.01) as significant predictors (r 2 value = 0.67) for increased gingival index in middle aged patients with T2DM. These variables significantly (p < 0.01) predispose middle-aged T2DM patients to increased gingival index, thus warranting appropriate intervention.
Highlights
The incidence of type 2 diabetes mellitus (T2DM) is ever growing in Southern Asia and is predicted to increase along with urbanization [1]
Of the 232 obese, middle aged T2DM subjects recruited in this study, 123 subjects with T2DM (53.01%) had no indications of periodontitis whereas 109 subjects (46.55%) with T2DM had chronic periodontitis
The mean values of BMI, Fasting blood glucose (FBG), HbA1c, mean pocket depth, and gingival index were comparatively higher in T2DM patients with significant differences in clinical attachment level (CAL), probing depth (PPD), and gingival index (Table 1)
Summary
The incidence of type 2 diabetes mellitus (T2DM) is ever growing in Southern Asia and is predicted to increase along with urbanization [1]. A bidirectional relationship exists between T2DM and periodontal disease [6] which is attributed to persisting hyperglycemia, leading to an exaggerated immunoinflammatory response to pathogenic microbial challenge in the gingiva [7]. In T2DM, persisting hyperglycemia causes non-enzymatic glycation and oxidation of proteins and lipids, leading to the subsequent formation of advanced glycation end products (AGEs) [8]. AGEs with accompanying markers for increased oxidative stress have been demonstrated in human gingiva in T2DM subjects with periodontitis, leading to rapid and severe periodontal tissue destruction [9]
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