Glucose variability and periodontal disease in type 1 diabetes: a cross-sectional study—The “PAROdontopatia e DIAbete” (PARODIA) project

Abstract

Aims Periodontal disease (PD) is a chronic inflammation of periodontal tissue associated with infection from specific anaerobic pathogens contained in dental plaque. Both type 1 and type 2 diabetes are associated with an increased prevalence of PDs. A two-way relationship between diabetes and periodontitis has been proposed, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control. To date, the relationship between PD and glucose variability in type 1 diabetes has not been evaluated. To investigate the prevalence of PD in patients with type 1 diabetes and its association with glycemic control and glucose variability. Methods In this cross-sectional study, all enrolled patients were scheduled to attend both a diabetologic and a periodontal visit. HbA1c, glucose coefficient of variation (CV), loss of clinical attachment (CAL), and periodontal probing depth (PPD) were collected. Results 136 patients were included in the analysis. The prevalence of PD was 63%. A significant correlation was found between mean CAL and glucose CV (r = 0.31, p = 0.002), but not with HbA1c. Mean PPD was also associated with glucose CV (r = 0.27 and 0.044), but not with HbA1c. In a multiple linear regression model, with mean CAL as dependent variable, age, glucose CV, and smoking habit resulted significantly associated (r = 0.23, p = 0.013; r = 0.33, p = 0.001; r = 0.34, p < 0.001, respectively). Assuming mean PPD as dependent variable, multiple linear regression analysis showed a significant association with glucose CV and smoking habits only. Conclusions PD is associated with glucose variability in patients with type 1 diabetes also after adjusting for the main confounders.

Association between chronic kidney disease and periodontitis. A systematic review and metanalysis

“…Progression of untreated PD leads to tooth loss, impaired quality of life (Cairo et al, 2018) and significant systemic inflammation (Linden et al, 2013). Several studies showed an association between PD and systemic diseases such as type 1 (Dicembrini et al, 2020, 2021) and type 2 diabetes mellitus (Genco & Borgnakke, 2013), cardiovascular disease (Tonetti & Van Dyke, 2013) and also Chronic kidney disease (CKD) (Chambrone et al, 2013; Deschamps‐Lenhardt et al, 2019; Kapellas et al, 2019; Zhao et al, 2018). Interestingly, PD and CKD share common risk factors, such as age, smoking and poorly controlled diabetes (Fisher et al, 2008).…”

Periodontal status and risk factors in patients with type 1 diabetes mellitus

“…Several studies suggests that the glycaemic control is of key importance in determining increased risk of periodontal disease [30]. This hypothesis was based on ndings of Dicembrini et al [9] and Jensen et al [34] who reported a signi cant correlation between the prevalence of PD and glycaemic control, which increased severity of early biomarkers of periodontal individuals. Pro-in ammatory cytokines are elevated in diabetes, which can increase the connective tissue damage and impair wound healing [11,13,14,35].…”

“…Periodontal disease is a chronic in ammation of periodontal tissue associated with infection from Gram-negative bacteria contained in dental plaque, promoting a chronic and progressive local in ammatory response [4][5][6][7][8]. The progressive destruction of connective tissue and bone support can result in tooth loss and systemic in ammation [9].…”

“…Periodontal disease is a chronic in ammation of periodontal tissue associated with infection from Gram-negative bacteria contained in dental plaque, promoting a chronic and progressive local in ammatory response [4][5][6][7][8]. The progressive destruction of connective tissue and bone support can result in tooth loss and systemic in ammation [9]. The mechanism of interaction implies the possible induction of systemic in ammation from periodontal tissues, increasing the level of circulating in ammatory markers that pay an important role in the initiation and progression of PD [5,[10][11][12][13][14].…”

Diabetes is associated with increased risk of death in COVID‐19 hospitalizations in Mexico 2020: A retrospective cohort study

“…The proposed mechanism is in disrupting the body's ability to mount a response and immune dysregulation. Increased inflammation increases the assault to the alveoli 16 . Diabetes also does not exist in isolation but is comorbid with a lot of other risk factors that are not independently associated such as hypertension and death.…”