Periodontal Disease and Incident Diabetes

Ide, Reiko; Hoshuyama, Tsutomu; Wilson, Donald; Takahashi, Ken; Higashi, Tomie

doi:10.1177/0022034510381902

Cited by 126 publications

(119 citation statements)

References 17 publications

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“…These SHIP data extended a previous cross-sectional report of elevated A1C levels among participants with periodontitis (20) as well as an earlier publication from NHANES I reporting increased levels of baseline periodontal disease to predict incident diabetes during two decades of follow-up (4). Although a recent study had equivocal findings for incident diabetes in a Japanese population (21), the mean follow-up time was only 6 years, which limited the number of incident cases and minimized power to detect the association observed. Collectively, these earlier studies were limited by an inability to address the potential role of insulin resistance as a mechanistic explanation of the aforementioned A1C change and incident diabetes findings.…”

Section: Discussionmentioning

confidence: 98%

Periodontal Infection, Systemic Inflammation, and Insulin Resistance

et al. 2012

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OBJECTIVEAdverse microbial exposures might contribute to diabetogenesis. We hypothesized that clinical periodontal disease (a manifestation of microbial exposures in dysbiotic biofilms) would be related to insulin resistance among diabetes-free participants. The roles of inflammatory mediation and effect modification were also studied.RESEARCH DESIGN AND METHODSThe continuous National Health and Nutrition Examination Survey 1999–2004 enrolled 3,616 participants (51% women) who received a periodontal examination and fasting blood draw. Participants were mean age (± SD) 43 ± 17 years and 28% Hispanic, 52% Caucasian, 17% African American, and 3% other. Log-transformed values of the homeostasis model assessment of insulin resistance (HOMA-IR) or HOMA-IR ≥3.30 (75th percentile) were regressed across full-mouth periodontal probing depth (PD) levels using linear and logistic models. White blood cell (WBC) count and C-reactive protein (CRP) were considered as either mediators or effect modifiers in separate analyses. Risk ratios (RRs) stem from marginal predictions derived from the logistic model. Results were adjusted for multiple periodontal disease and insulin resistance risk factors.RESULTSIn linear regression, geometric mean HOMA-IR levels increased by 1.04 for every 1-mm PD increase (P = 0.007). WBC mediated 6% of the association (P < 0.05). Among participants with WBC ≤6.4 × 109, PD was unrelated to HOMA-IR ≥3.30. Fourth-quartile PD was associated with HOMA-IR ≥3.30 among participants with WBC >7.9 × 109; RR 2.60 (1.36–4.97) (P for interaction = 0.05). Findings were similar among participants with CRP >3.0 mg/L (P for interaction = 0.04).CONCLUSIONSPeriodontal infection was associated with insulin resistance in a nationally representative U.S. sample of diabetes-free adults. These data support the role of inflammation as both mediator and effect modifier of the association.

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Section: Discussionmentioning

confidence: 98%

Periodontal Infection, Systemic Inflammation, and Insulin Resistance

et al. 2012

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“…52 A long-term, largescaled follow-up study in Japan indicated no significant difference between periodontal treatment and the incidence of diabetes, but did suggest periodontitis as an increased risk for developing diabetes. 53 Taken together, of clinical relevance to us is that dentists should treat the periodontal condition in a patient's mouth and manage the patient's diabetic condition, in order to achieve optimal results after periodontal therapy. While good periodontal health might not necessarily be accompanied by a change in glycemic control, an improvement can potentially modify metabolic control, leading to an overall enhancement in the quality of life.…”

Section: Effects Of Periodontal Therapy On Periodontal Health and Glymentioning

confidence: 99%

Interrelationships of periodontitis and diabetes: A review of the current literature

Chang

Lim

2012

Journal of Dental Sciences

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Diabetes and periodontitis are common chronic diseases in the world, and abundant epidemiological evidence implies a bidirectional relationship between the two diseases. It appears that diabetes is a risk factor for greater periodontal destruction, whereas managing periodontitis can also contribute to better glycemic control. The underlying regulatory mechanisms are also bidirectional. The hyperglycemic status may directly alter subgingival microbial compositions, impair cellular function, and change collagen metabolism. The formation of advanced glycation end-products (AGEs) can further modify the extracellular matrix, and establishment of cellular receptor binding can amplify inflammation. Moreover, periodontitis also induces hyperlipidemia and insulin resistance. This cyclical relationship converges via overproduction of proinflammatory cytokines, such as tumor necrosis factor-a and interleukin-1b. Thus, this article highlights the importance of maintaining periodontal health to eliminate systemic complications and meticulous metabolic control to prevent further periodontal destruction. From a systemic aspect, targeting proinflammatory cytokines or receptors of AGEs could be a potential modality for treating periodontitis.

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“…Several studies support an association between periodontal disease and risk of chronic systemic conditions, including vascular disease, chronic obstructive pulmonary disease, diabetes mellitus, and cancer, including gastric adenocarcinoma. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 These associations may be mediated by systemic inflammation, the immune response to periodontal infection, or direct invasion by pathogens. Previous studies of periodontal disease and risk of peptic ulcer have been limited by cross-sectional design, diagnoses that were not confirmed by medical record review, and a lack of information on key confounders, including smoking, aspirin and non-steroidal anti-inflammatory drug (NSAID) use, socioeconomic status, and Helicobacter pylori infection status.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study of Periodontal Disease and Risk of Gastric and Duodenal Ulcer in Male Health Professionals

Boylan

Khalili

Huang³

et al. 2014

Clinical and Translational Gastroenterology

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OBJECTIVES:Periodontal disease has been associated with higher circulating levels of inflammatory markers and conditions associated with chronic inflammation, including vascular disease, diabetes mellitus, and cancer. Limited data exist on the relationship between periodontal disease and gastric and duodenal ulcer.METHODS:We conducted a prospective cohort study of 49,120 men in the Health Professionals Follow-up Study, aged 40–75 years at enrollment in 1986. Biennially, we assessed periodontal disease, tooth loss, and other risk factors for gastric and duodenal ulcer. We validated diagnoses of gastric and duodenal ulcer through medical record review. We used Cox proportional hazards modeling, adjusting for potential confounders, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).RESULTS:We documented 138 cases of gastric ulcer and 124 cases of duodenal ulcer with available information on Helicobacter pylori status over 24 years of follow-up. After adjustment for risk factors, including smoking and regular use of aspirin and non-steroidal anti-inflammatory drugs, men with periodontal disease with bone loss had a multivariate HR of ulcer of 1.62 (95% CI, 1.24–2.12). Periodontal disease appeared to be associated with a similar risk of developing ulcers that were H. pylori negative (HR 1.75; 95% CI, 1.26–2.43) than H. pylori positive (HR 1.40; 95% CI, 0.87-2.24), as well as ulcers in the stomach (HR 1.75; 95% CI, 1.21–2.53) than ulcers in the duodenum (HR 1.47; 95% CI, 0.98–2.19).CONCLUSIONS:Periodontal disease is associated with an increased risk of incident gastric and duodenal ulcer. This relationship may be mediated by alterations in the oral and gastrointestinal microbiome and/or systemic inflammatory factors.

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Periodontal Disease and Incident Diabetes

Cited by 126 publications

References 17 publications

Periodontal Infection, Systemic Inflammation, and Insulin Resistance

Periodontal Infection, Systemic Inflammation, and Insulin Resistance

Interrelationships of periodontitis and diabetes: A review of the current literature

A Prospective Study of Periodontal Disease and Risk of Gastric and Duodenal Ulcer in Male Health Professionals

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