Periodontal inflammation correlates with systemic inflammation and insulin resistance in patients with recent diagnosis of type 2 diabetes

  • Natacha Oyarzo Escuela de Odontología, Facultad de Medicina, Pontificia Universidad Católica de Chile
  • María Riveros Departamento de Nutrición, diabetes y metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile
  • Constanza Andaur Escuela de Odontología, Facultad de Medicina, Pontificia Universidad Católica de Chile
  • Jessica Liberona Departamento de Nutrición, diabetes y metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile
  • Víctor Cortés Departamento de Nutrición, diabetes y metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile
Palabras clave: diabetes, periodontitis, C reactive protein, insulin resistance, inflammation, chronic disease

Resumen

Background: diabetes and periodontitis are common comorbidities; however, the clinical implications of this association remain only partially known. This study was aimed to characterize the periodontal status of type 2 diabetic (T2D) patients and its correlation with metabolic and inflammatory parameters. Methods: patients (n = 30) with 5 or less years since the diagnosis of T2D (18 – 65 years old) were recruited. Anthropometric (Body Mass Index, BMI), metabolic (fasting glucose, glycated hemoglobin, insulin, HOMA-IR, HDL, LDL and total cholesterol, triglycerides) and inflammatory parameters (ultrasensitive C reactive protein, usCRP) were quantified. Periodontal evaluation included clinical attachment level (CAL), probing depth (PD), gingival level (GL) and bleeding on probing (BOP) average. Statistical significance was assessed by Mann-Whitney and Spearman correlation tests. Results: mean values of BOP, CAL, PD and GL were 39.3, 2.8, 2.8, and 0.1, respectively. BOP significantly correlated with BMI and HOMA-IR and was higher in patients with elevated usCRP >3 mg/L (p<0.05). Age and duration of T2D directly and inversely correlated with CAL and GL, respectively. BOP correlated with HOMA-IR and usCRP but not with patients´age, duration of T2D or BMI. Conclusions: in patients with recent diagnosis of T2D, BOP is associated with usCRP and HOMA-IR levels, suggesting that periodontal inflammation promotes insulin resistance possibly by increasing systemic inflammation.

Descargas

La descarga de datos todavía no está disponible.

Metrics

Cargando métricas ...

Citas

American Academy of Periodontology (2000). Parameter on chronic periodontitis with advanced loss of periodontal support. J Periodontal 74, 856-858

Borgnakke WS, Ylöstalo PV, Taylor GW & Genco RJ. (2013). Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence. Journal of periodontology 84, 135-152.

Casanova L, Hughes F & Preshaw P. (2014). Diabetes and periodontal disease: a two-way relationship. British dental journal 217, 433-437.

Cerda J, Delatorre C, Malacara J & Nava L. (1994). Periodontal-disease in non-insulin-dependent diabetes-mellitus (niddm) - the effect of age and time since diagnosis. Journal of Periodontology 65, 991-995.

Chaffee B & Weston S. (2010). Association Between Chronic Periodontal Disease and Obesity: A Systematic Review and Meta-Analysis. Journal of Periodontology 81, 1708-1724.

Chapple L & Genco R. (2013). Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. Journal of clinical periodontology 40 (14).

Colombo N, Shirakashi D, Chiba F, De Lima Coutinho M, Ervolino E, Saliba C & Sumida D. (2012). Periodontal Disease Decreases Insulin Sensitivity and Insulin Signaling. Journal of Periodontology 83, 864-870.

D'Aiuto F, Ready D & Tonetti M. (2004). Periodontal disease and C‐reactive protein‐associated cardiovascular risk. Journal of periodontal research 39, 236-241.

Demmer R, Squillaro A, Papapanou P. Rosenbaum M, Friedewald W, Jacobs D & Desvarieux M (2012). Periodontal Infection, Systemic Inflammation, and Insulin Resistance Results from the continuous National Health and Nutrition Examination Survey (NHANES) 1999–2004. Diabetes care 35, 2235-2242.

Engebretson S, Hyman LG, Michalowicz BS, Schoenfeld ER, Gelato MC, Hou W & Tsai M. (2013). The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial. JAMA 310, 2523-2532.

Engebretson S. & Kocher T. (2013). Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta‐analysis. Journal of clinical periodontology 40 (14).

Gamonal J, Mendoza C, Espinoza I, Munoz A, Urzua I, Aranda W & Arteaga O. (2010). Clinical Attachment Loss in Chilean Adult Population: First Chilean National Dental Examination Survey. Journal of Periodontology 81, 1403-1410.

Genco R & Borgnakke W. (2013). Risk factors for periodontal disease. Periodontology 2000 62, 59-94.

Gomes-Filho I, Freitas J, da Cruz S, Passos JS, Teixeira de Freitas CO, Aragão Farias NS, Amorim da Silva R, Silva Pereira MN, Lima TL & Barreto ML (2011). Chronic periodontitis and C-reactive protein levels. Journal of periodontology 82, 969-978.

Gorman A, Kaye E, Apovian C, Fung T, Nunn M, & Garcia R. (2012). Overweight and obesity predict time to periodontal disease progression in men. Journal of clinical periodontology 39, 107-114.

GraphPad Software (s.f.). San Diego, USA. Web site: http://www.graphpad.com/quickcalcs/ConfInterval1.cfm Acceded 15-08-2018

Gurav, Abhijit N. (2012). Periodontitis and insulin resistance: casual or causal relationship? Diabetes & metabolism journal 36, 404-411.

Hajishengallis G. (2015). Periodontitis: from microbial immune subversion to systemic inflammation. Nature Reviews Immunology 15, 30-44.

IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.

Lakschevitz F, Aboodi G, Tenenbaum H & Glogauer M. (2011). Diabetes and periodontal diseases: interplay and links. Current diabetes reviews 7, 433-439.

Loos B. (2005). Systemic markers of inflammation in periodontitis. Journal of periodontology 76, 2106-2115.

Löe H. (1993). Periodontal disease: the sixth complication of diabetes mellitus. Diabetes care 16, 329-334.

Mealey B. (2006). Periodontal disease and diabetes - A two-way street. Journal of the American Dental Association 137, 26-31.

Ministerio de Salud de Chile. (2010). Encuesta Nacional de Salud 2009-2010. In: MINSAL Santiago de Chile. Web site: https://www.minsal.cl/portal/url/item/bcb03d7bc28b64dfe040010165012d23.pdf Acceded: 02-09-2018

Nelson R, Shlossman M, Budding L, Pettitt D, Saad M, Genco R. & Knowler W. (1990). Periodontal-disease and niddm in pima-indians. Diabetes Care 13, 836-840.

Papageorgiou S, Reichert C, Jaeger A & Deschner J. (2015). Effect of overweight/obesity on response to periodontal treatment: systematic review and a meta-analysis. Journal of Clinical Periodontology 42, 247-261.

Pejcic A, Kesic L & Milasin J (2011). C-reactive protein as a systemic marker of inflammation in periodontitis. European journal of clinical microbiology & infectious diseases 30, 407-414.

Petersen P & Ogawa H. (2012). The global burden of periodontal disease: towards integration with chronic disease prevention and control. Periodontology 2000 60, 15-39.

Pickup J. (2004). Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes. Diabetes care 27, 813-823.

Pranckeviciene A, Siudikiene J, Ostrauskas R & Machiulskiene V. (2014). Severity of periodontal disease in adult patients with diabetes mellitus in relation to the type of diabetes. Biomedical Papers 158, 117-123.

Preshaw P, Alba A, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K & Taylor R. (2012). Periodontitis and diabetes: a two-way relationship. Diabetologia 55, 21-31.

Saito T, Shimazaki Y, Koga T, Tsuzuki M & Ohshima A. (2001). Relationship between upper body obesity and periodontitis. Journal of Dental Research, 80, 1631-1636.

Samuel V. & Shulman G. (2016). The pathogenesis of insulin resistance: integrating signaling pathways and substrate flux. Journal of Clinical Investigation 126, 12.

Sandberg G, Sundberg H, Fjellstrom C & Wikblad K. (2000). Type 2 diabetes and oral health: a comparison between diabetic and non-diabetic subjects. Diabetes research and clinical practice 50, 27-34.

Schatzle M, Loe H, Burgin W, Anerud A, Boysen H & Lang N. (2003). Clinical course of chronic periodontitis - I. Role of gingivitis. Journal of Clinical Periodontology 30, 887-901.

Sgolastra F, Severino M, Pietropaoli D, Gatto R & Monaco A. (2013). Effectiveness of periodontal treatment to improve metabolic control in patients with chronic periodontitis and type 2 diabetes: a meta-analysis of randomized clinical trials. Journal of periodontology 84, 958-973.

Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, Stevenson B, Furness S. & Iheozor-Ejiofor Z. (2015). Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev 6

Sun W, Chen L, Zhang S, Wu Y, Ren Y & Qin G. (2011). Inflammatory cytokines, adiponectin, insulin resistance and metabolic control after periodontal intervention in patients with type 2 diabetes and chronic periodontitis. Internal medicine 50, 1569-1574.

Tsai C, Hayes C & Taylor G. (2002). Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population. Community Dentistry and Oral Epidemiology 30, 182-192.

Publicado
2019-01-28
Cómo citar
Oyarzo, N., Riveros, M., Andaur, C., Liberona, J., & Cortés, V. (2019). Periodontal inflammation correlates with systemic inflammation and insulin resistance in patients with recent diagnosis of type 2 diabetes. ARS MEDICA Revista De Ciencias Médicas, 44(1), 6-12. https://doi.org/10.11565/arsmed.v44i1.1524
Sección
Artículos de investigación