Periodontitis and Risk of Diabetes in the Atherosclerosis Risk In Communities (ARIC) Study: A BMI-Modified Association

High remnant cholesterol as a risk factor for developing chronic kidney disease in patients with prediabetes and type 2 diabetes: a cross-sectional study of a US population

AIMS

To examine any potential links between remnant cholesterol (RC) and comorbid chronic kidney disease (CKD) in individuals with prediabetes and type 2 diabetes mellitus (T2DM).

METHODS

We used data from 2709 American people aged > 20 years from the National Health and Nutrition Examination Survey (NHANES) during 2011-2018. Subjects were categorized according to whether they had comorbid CKD. Logistic regression models and smoothed curve fitting methods were employed to assess the association of RC with comorbid CKD in patients with prediabetes and T2DM.

RESULTS

The 2709 participants included 1473 patients with T2DM and 1236 with prediabetes [impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)], of whom 744 (27.46%) had comorbid CKD. In multivariate-adjusted analysis, both RC and triglycerides (TG) were significantly associated with an increased risk of comorbid CKD, and a 1 mmol/L elevation of RC increased the risk by 38.1% [OR (95% CI) 1.636 (1.242, 2.156)], which was higher than the risk associated with a 1 mmol/L increase in TG [1.255 (1.106, 1.424)]. Additionally, those in the highest quartile of RC had a 43.6% higher risk of concomitant renal damage than those in the lowest quartile. RC was linearly and positively associated with the incidence of comorbid CKD in this population.

CONCLUSIONS

RC is an independent risk factor for comorbid CKD in patients with prediabetes and T2DM. This finding provides a novel insight into the management and early detection of renal disease in patients with impaired glucose metabolism.

Clinical attachment loss is cross-sectionally associated with elevated glucose among adults without diabetes

AIM

We investigated whether periodontal measures are cross-sectionally associated with prediabetes and cardiometabolic biomarkers among non-diabetic younger adults.

MATERIALS AND METHODS

One thousand seventy-one participants (mean age = 32.2 years [SE = 0.3]; 73% female) from the Oral Infections, Glucose Intolerance and Insulin Resistance Study were enrolled. Full-mouth clinical attachment loss (fm-CAL), probing depth (fm-PD) and bleeding on probing were ascertained. Interproximal CAL (i-CAL) and probing depths (i-PD) served as our primary exposures. Glucose, HbA1c, insulin and insulin resistance (HOMA-IR) outcomes were assessed from fasting blood. Prediabetes was defined per American Diabetes Association guidelines. Prediabetes prevalence ratios (PR [95% CI]) and mean [SE] cardiometabolic biomarkers were regressed on periodontal variables via multivariable robust variance Poisson regression or multivariable linear regression.

RESULTS

Prevalence of prediabetes was 12.5%. Fully adjusted prediabetes PR in Tertiles 3 versus 1 of mean i-CAL was 2.42 (1.77, 3.08). Fully adjusted fasting glucose estimates across i-CAL tertiles were 83.29 [0.43], 84.31 [0.37], 86.48 [0.46]; p for trend <.01. Greater percent of sites with i-PD ≥3 mm showed elevated natural-log-HOMA-IR after adjustment (0%-12% of sites = 0.33 [0.03], 13%-26% of sites = 0.39 [0.03], ≥27% of sites = 0.42 [0.03]; p for trend = .04).

CONCLUSIONS

i-CAL (vs. fm-CAL) was associated with elevated fasting glucose and prediabetes, whereas i-PD (vs. fm-PD) was associated with insulin resistance. Future studies are needed to examine periodontal disease and incident prediabetes.

Association between the number of teeth and incident pre-diabetes among middle-aged adults with periodontal disease: a retrospective cohort analysis of Japanese claims data

OBJECTIVES

To investigate the association between the number of teeth and the new onset of pre-diabetes.

DESIGN

Retrospective cohort study.

SETTING

The National Database of Health Insurance Claims and Specific Health Checkups of Japan, which holds information from both the yearly health check-up programme known as the 'Specific Health Checkup' and health insurance claims data.

PARTICIPANTS

1 098 371 normoglycaemic subjects who participated in the Specific Health Checkup programme every year from fiscal year (FY) 2015 to FY 2018 and had dental insurance claims data with a diagnosis of periodontal disease during FY 2016.

OUTCOME MEASURES

Incidence of pre-diabetes or diabetes observed at the Specific Health Checkup during FY 2018.

RESULTS

Among the participants, 1 77 908 subjects developed pre-diabetes, and 579 developed diabetes at the check-up during the subsequent follow-up year. Compared with the subjects with 26-28 teeth, those with 20-25, 15-19 or 1-14 teeth were associated with an increased likelihood of developing pre-diabetes or diabetes onset with adjusted ORs of 1.03 (95% CI: 1.02 to 1.05), 1.06 (1.03 to 1.09) and 1.07 (1.04 to 1.11), respectively. No clear modifications were observed for age, sex, body mass index or current smoking.

CONCLUSIONS

Having fewer teeth was associated with a higher incidence of pre-diabetes. Due to the limitations of this study, however, causality remains undetermined.

Comparative analysis of subgingival microbiota in patients with mild, moderate, and severe chronic periodontitis

In this study, we explored the suspected pathogens of chronic periodontitis at different stages of occurrence and development. We collected 100 gingival crevicular fluid samples, 27, 27, and 26 from patients with mild, moderate, and severe chronic periodontitis, respectively, and 20 from healthy individuals. Pathogens were detected using a 16S rRNA metagenomic approach. Quantitative Insights in Microbial Ecology, Mothur, and other software were used to analyze the original data, draw relative abundance histograms and heat maps, and calculate flora abundance and diversity indexes. We identified 429 operational taxonomic units, covering 13 phyla, 20 classes, 32 orders, 66 families, and 123 genera from the four groups of samples. Each group showed microbial diversity, and the number of new species of bacterial flora in the gingival crevicular fluid samples gradually increased from the healthy to the severe chronic periodontitis group. There was a significant difference in the relative abundance of the core flora at the phylum, class, order, family, and genus classification levels. Our data indicated a certain correlation between the changes in the subgingival microbial structure and the occurrence and development of chronic periodontitis, which might be able to provide a reference for the diagnosis, treatment and prevention of chronic periodontitis.

Remnant cholesterol, but not other cholesterol parameters, is associated with gestational diabetes mellitus in pregnant women: a prospective cohort study

OBJECTIVE

No evidence has been found of a relationship between remnant cholesterol (RC) and the likelihood of gestational diabetes mellitus (GDM) in pregnant women. The aim of our study was to investigate the link between serum RC at 12-14 weeks of gestation and the risk of GDM.

METHODS

This was a secondary analysis with data from a prospective cohort study in Korea. A total of 590 single pregnant women attending two hospitals in Korea, up to 14 weeks gestation, from November 2014 to July 2016 were included in the study. The formula used to calculate RC in detail was RC (mg/dL) = TC (mg/dL)-HDL-c (mg/dL)-LDL-c (mg/dL). Logistic regression models were employed to examine the relationship between RC and GDM and explore the association between other lipoprotein cholesterol parameters and the risk of GDM. Furthermore, receiver operating characteristic (ROC) analysis was performed to assess the ability of RC to identify GDM. Additionally, sensitivity and subgroup analyses were conducted.

RESULTS

The mean age of participants was 32.06 ± 3.80 years. The median of RC was 34.66 mg/dL. 37 pregnant women (6.27%) were eventually diagnosed with GDM. Multivariate adjusted logistic regression analysis showed that RC was positively associated with the risk of GDM (OR = 1.458, 95% CI 1.221, 1.741). There was no significant association between other lipoprotein cholesterols (including TC, LDL-c, HDL-c) and the risk of GDM. The area under the ROC curve for RC as a predictor of GDM was 0.8038 (95% CI 0.7338-0.8738), and the optimal RC cut-off was 24.30 mg/dL. Our findings were demonstrated to be robust by performing a series of sensitivity analyses.

CONCLUSION

Serum RC levels at 12-14 weeks of gestation are positively associated with GDM risk in pregnant women. RC in early pregnancy is an early warning indicator of GDM in pregnant women, especially those with normal HDL-c, LDL-c, and TC that are easily overlooked. There is a high risk of developing GDM in pregnant women whose RC is more than 24.30 mg/dL. This study may help optimize GDM prevention in pregnant women and facilitate communication between physicians, pregnant patients, and their families.

Oral health status and risk of incident diabetes: a prospective cohort study of 213,389 individuals aged 45 and over

AIMS

To examine whether simple measures of oral health are associated with incident diabetes.

METHODS

This prospective cohort study linked data from the 45 and Up Study, Australia, to administrative health records. The study participants were 213,389 men and women, aged ≥ 45 years, with no diabetes at baseline. The oral health of participants was assessed by questionnaire. Incident diabetes cases were ascertained based on self-report in follow-up questionnaires, linked data on medical and pharmaceutical claims, and hospitalisation data up until 2019. The association between oral health and incident diabetes were calculated using multivariable cox proportional hazards models.

RESULTS

During 2,232,215 person-years of follow-up, 20,487 (9.6%) participants developed diabetes. Compared with those with ≥20 teeth, the adjusted hazard ratio (aHR) for incident diabetes was 1.12 (95% Confidence Interval (CI): 1.08, 1.17) for 10-19 teeth, 1.20 (1.14, 1.26) for 1-9 teeth and 1.15 (1.09, 1.21) for no teeth. Compared with those with excellent/very good teeth and gums, the aHR for incident diabetes was 1.07 (1.03, 1.12) for fair and 1.13 (1.07, 1.20) for poor teeth and gums.

CONCLUSIONS

Simple measures of oral health were associated with risk of developing diabetes, demonstrating the potential importance of oral health screening for diabetes prevention.

A cross-sectional study on the relationship between visceral adiposity index and periodontitis in different age groups

Obesity and periodontitis are significantly related, and the visceral adiposity index (VAI) is an important indicator of obesity. This study aimed to investigate the association between VAI and periodontitis. The study included participants from the 2009-2014 cycle of the National Health and Nutrition Examination Survey who received a complete periodontal exam and VAI record. Periodontitis, according to the Centers for Disease Control and Prevention-American Academy of Periodontology periodontitis case definitions, is categorized into the following: no periodontitis, moderate periodontitis, mild periodontitis, and severe periodontitis. Hierarchical analysis, multivariable logistic regression, and restricted cubic spline regression were conducted to investigate the relationship between periodontitis and VAI in adults. There was no significant relationship between VAI and the prevalence of periodontitis in all age groups (P = 0.08). Age-stratified analysis showed a significant association between periodontitis and VAI in adults aged 40-50 years (P < 0.001). After adjusting for all covariates, the association between periodontitis and VAI remained significant in the 40-50-years age group (the trend P value = 0.014). Restricted cubic spline analysis showed a non-linear relationship between VAI and periodontitis (P for non-linear = 0.002). Visceral adiposity index was significantly associated with periodontitis risk in the 40-50-year-old group, and the relationship between VAI and periodontitis risk was found to be non-linear.

Evidence Linking PPARG Genetic Variants with Periodontitis and Type 2 Diabetes Mellitus in a Brazilian Population

The peroxisome proliferator-activated receptor gamma (PPARG) gene encodes a transcription factor involved in the regulation of complex metabolic and inflammatory diseases. We investigated whether single nucleotide polymorphisms (SNPs) and haplotypes of the PPARG gene could contribute with susceptibility to develop periodontitis alone or together with type 2 diabetes mellitus (T2DM). Moreover, we evaluated the gene-phenotype association by assessing the subjects' biochemical and periodontal parameters, and the expression of PPARG and other immune response-related genes. We examined 345 subjects with a healthy periodontium and without T2DM, 349 subjects with moderate or severe periodontitis but without T2DM, and 202 subjects with moderate or severe periodontitis and T2DM. PPARG SNPs rs12495364, rs1801282, rs1373640, and rs1151999 were investigated. Multiple logistic regressions adjusted for age, sex, and smoking status showed that individuals carrying rs1151999-GG had a 64% lower chance of developing periodontitis together with T2DM. The CCGT haplotype increased the risk of developing periodontitis together with T2DM. The rs1151999-GG and rs12495364-TC were associated with reduced risk of obesity, periodontitis, elevated triglycerides, and elevated glycated hemoglobin, but there was no association with gene expression. Polymorphisms of the PPARG gene were associated with developing periodontitis together with T2DM, and with obesity, lipid, glycemic, and periodontal characteristics.

Laser treatments as an adjunct to non-surgical periodontal therapy in subjects with periodontitis and type 2 diabetes mellitus: a systematic review and meta-analysis

OBJECTIVES

Periodontal disease and diabetes have an extensively investigated bidirectional correlation. Non-surgical periodontal treatment (NSPT) was proven to contribute to glycemic control. Moreover, it may benefit from the association of adjunctive therapies. The aim of the present systematic review is to assess the clinical efficacy of NSPT in association with laser (LT) or photodynamic therapy (PDT) in controlled or uncontrolled diabetic patients, and to grade the level of evidence.

MATERIALS AND METHODS

Randomized controlled clinical trials with at least 3-month follow-up were searched in MEDLINE via OVID, EMBASE, and Cochrane Central, screened for inclusion, and grouped based on the performed treatments, follow-up time, type of diabetes, and level of glycemic control.

RESULTS

Eleven RCTs with 504 total subjects were included. The adjunct of PDT showed a statistically significant 6-month difference in PD changes (with low certainty of evidence), but not in CAL changes, while a significant difference in 3-month PD and CAL changes was found with the adjunct of LT (low certainty of evidence). Patients treated with PDT registered a higher decrease in HbA1c levels at 3 months, but no significant difference was noted at 6 months; LT also led to better HbA1c changes at 3 months with a moderate certainty of evidence.

CONCLUSION

Despite the promising short-term HbA1c decrease, the results should be interpreted with caution due to the small effect sizes and the statistical heterogeneity, and further evidence from well-designed RCTs is needed to support the routine use of PDT or LT in adjunct to NSPT.

Effect of periodontal therapy on insulin resistance in adults with dysglycemia and periodontitis: a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to address whether non-surgical periodontal therapy (NSPT) can affect insulin resistance, estimated by the homeostasis model assessment (HOMA), in adults with prediabetes or type 2 diabetes mellitus and periodontitis.

MATERIALS AND METHODS

Six electronic databases and the gray literature were systematically searched for interventional studies reporting NSPT effect on insulin resistance. Seven studies met the eligibility criteria to be synthesized in the qualitative analysis, six reporting change in HOMA-IR, three reporting change in HOMA-%S, and two in HOMA-β. Among them, four were pooled in a meta-analysis of standardized mean difference (SMD) of HOMA-IR; comparing pre- and post-intervention values, three were pooled considering HOMA-%S as outcome, and two studies were summarized considering SMD of HOMA-%S between intervention and control groups. HOMA-β results were qualitatively synthetized.

RESULTS

With low level of certainty, NSPT significantly reduced HOMA-IR, when compared with pre-intervention data (SMD, -0.35, 95% CI -0.63 to 0.07, p=0.02). There were no significant changes in HOMA-%S or in HOMA-β scores. The level of certainty was very low and moderate, respectively.

CONCLUSIONS

Assertions about a causal link between NSPT and insulin resistance are weak and conflicting, although our more robust results point out to the absence of effect. .

CLINICAL RELEVANCE

Because further high-quality studies assessing the relationship between periodontitis and insulin resistance are need, the findings of the current systematic review are limited to give recommendations for clinicians. However, while identifying a lack of research in humans with T2D concerning periodontitis and insulin resistance, this study reinforces the need of multicenter well-designed randomized clinical trials.

Association between type 2 diabetes (T2D) and tooth loss: a systematic review and meta-analysis

BACKGROUND

Several studies have assessed the relationship between type 2 diabetes (T2D) and tooth loss; however, results have been inconsistent. Therefore, the present systematic review and meta-analysis of observational studies was designed to examine the association between T2D and tooth loss.

METHODS

This systematic review and meta-analysis was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guideline. We searched all the relevant studies in international databases of Scopus, PubMed, ProQuest, Web of Science, Cochrane Library, and Google scholar search engine until February 2022. The heterogeneity of the studies was calculated using the I² index. Measure of effect and 95% confidence interval (CI) were extracted from each study. The results of the study were analyzed using the random effects model.

RESULTS

In the present study, 22 eligible studies were included. Meta-analysis of unadjusted and adjusted results showed that T2D significantly increased the risk of tooth loss, and Odds Ratio (OR) unadjusted was 1.87 (95% CI: 1.62-2.13, p < 0.001), and OR adjusted was 1.20 (95% CI: 1.10-1.30, p < 0.001), respectively. Subgroup analysis based on study design for adjusted OR indicated that in the cohort study (OR: 1.29, 95% CI: 1.07-1.51), in the cross-sectional study (OR: 1.15, 95% CI: 1.06-1.23), and in the case-control study (OR: 5.10, 95% CI: 1.01-9.18) there was a significant association between T2D and tooth loss. Other subgroups analyses showed consistent results and no publication bias existed.

CONCLUSIONS

The findings suggest that T2D is associated with increased risk of tooth loss. This conclusion may provide useful evidence for correlated clinical researches.