This article is more than 5 years old. Information may no longer be current.
Periodontal disease associated with type 2 diabetes
Researchers question which comes first: periodontal disease or diabetes.
Click Here to Manage Email Alerts
Periodontal disease may be an independent predictor of incident type 2 diabetes, according to research published in Diabetes Care.
“We found that over 20 years of follow-up, individuals who had periodontal disease at baseline were more likely to develop type 2 diabetes later in life,” said Ryan T. Demmer, PhD, MPH, associate research scientist at Mailman School of Public Health, Columbia University.
Demmer and colleagues studied 9,296 participants without diabetes who were enrolled in the National Health and Nutrition Examination Survey 1971-1976. They classified 7,168 periodontally healthy participants based on six categories of periodontal disease — ranging from no periodontal disease, or a score of zero, to severe periodontal disease, or a score of six.
The researchers reported 817 cases of incident diabetes (cumulative incidence = 9%).
The association between periodontal disease and incident type 2 diabetes persisted regardless of periodontal disease definition, according to the study. Those with no or mild periodontal disease did not have elevated odds ratios for incident type 2 diabetes. However, those with moderate periodontal disease (score 3) had the greatest OR of 2.26, followed by those with moderately severe disease (score 4) with an OR of 1.71 and those with severe disease (score 5) with an OR of 1.50. Participatns with advanced tooth loss had an OR of 1.70. Those who had lost all of their teeth were at intermediate risk for incident diabetes.
“This could be suggestive that the people who lost all of their teeth had a history of infection at some point, but subsequently lost their teeth and removed the source of infection,” Demmer told Endocrine Today.
Participants with periodontal disease tended to be older, male, non-white, smokers and of low socioeconomic status.
Examining the association
“It is well-known that patients with type 1 and type 2 diabetes have more periodontal disease compared with people who do not have diabetes. It has always been viewed that diabetes is a risk factor for periodontal infections,” he said.
These data add a new twist to this association: periodontal disease may be there before diabetes, according to Demmer. No clear-cut causal link between periodontal disease and diabetes has been established. Additional observational studies are needed to confirm this link in different populations and using different definitions of periodontal disease, according to the study. – by Katie Kalvaitis
Diabetes Care. 2008;31:1373-1379.
I think this paper is very important for demonstrating that periodontal disease predicts incident diabetes. There is growing recognition on the part of the medical community that periodontal disease has a more complex relationship with diabetes than previously thought. For some time, it was widely believed that periodontal disease was worsened by the presence of diabetes, but this paper provides compelling evidence that it also predicts diabetes. Work from other investigators suggests that the presence of periodontal disease also predicts the more rapid development of diabetes complications.
As the authors noted, measures of fasting glucose were not available in the cohort, so it is possible than an undeterminable number of the incident cases of diabetes actually had undiagnosed diabetes at baseline. Hence, confirmation of this finding in other cohorts in whom the diagnosis of diabetes is known with greater certainty is required. Nevertheless, what used to be considered a disease confined to the oral cavity is increasingly being recognized as a disease that affects the entire vasculature; periodontal disease increases the risk of cardiovascular disease and, in those with diabetes, the risk of kidney disease.
From a management perspective, what needs to be determined is whether aggressive management of periodontal disease will reduce the risk of diabetes and the risk of diabetes complications. Until these studies are done, knowledge of this putative association between periodontal disease and diabetes should influence screening strategies for diabetes.
– Robert G. Nelson, MD, PhD
Staff Clinician, Diabetes and Arthritis Epidemiology Section,
Phoenix Epidemiology and Clinical Research Branch, NIDDK, NIH