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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2017, Vol. 11 Issue (1) : 110-119     DOI: 10.1007/s11684-016-0484-5
RESEARCH ARTICLE |
Association of periodontal disease with glycemic control in patients with type 2 diabetes in Indian population
Palka Kaur Khanuja1(),Satish Chander Narula1,Rajesh Rajput2,Rajinder Kumar Sharma1,Shikha Tewari1
1. Department of Periodontics and Oral Implantology; PGIDS Post Graduate Institute of Dental Sciences, Rohtak, Haryana 124001, India
2. Department of Medicine Unit VII and Endocrinology; PGIMS Post Graduate Institute of Medical Sciences, Rohtak, Haryana 124001, India
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Abstract  

This study aims to investigate the link between glycated hemoglobin and diabetic complications with chronic periodontitis. A total of 207 patients with type 2 diabetes and chronic periodontitis (CP) were divided according to tertiles of mean PISA (periodontal inflamed surface area) scores as low, middle and high PISA groups. Simultaneously a group of 67 periodontally healthy individuals (PH) was recruited. Periodontal examinations, including full-mouth assessment of probing depths (PPD), bleeding on probing, clinical attachment level and plaque scores were determined. Blood analyses were carried out for glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2 h post parandial glucose (PPG). Individuals in PH group had significantly better glycemic control than CP group. Upon one-way analysis of variance, subjects with increased PISA had significantly higher HbA1c levels, retinopathy and nephropathy (P<0.05). After controlling for age, gender, body mass index (BMI), socioeconomic status (SES), family history of diabetes and periodontitis, duration of diabetes, the mean PISA in mm2, PPD 4--6 mm (%) and PPD≥7 mm (%) emerged as significant predictors for elevated HbA1c in regression model (P<0.05). Logistic regression analysis revealed that PISA was associated with higher risk of having retinopathy and neuropathy (odds ratio). In our study, the association between glycemic control and diabetic complications with periodontitis was observed.

Keywords type 2 diabetes mellitus      hemoglobin A      glycated      chronic periodontitis     
Corresponding Authors: Palka Kaur Khanuja   
Just Accepted Date: 01 December 2016   Online First Date: 30 December 2016    Issue Date: 20 March 2017
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-016-0484-5     OR     http://academic.hep.com.cn/fmd/EN/Y2017/V11/I1/110
Fig.1  Enrollment and participation of the study participants.
Variable Periodontally healthy (PH) group
(Total= 67)
Chronic periodontitis (CP) group
(Total= 207)
P
Age (year; mean±SD) 52.21±6.96 53.81±7.18 NS
Male/female (n) 34/33 (50.74%/49.25%) 102/105 (49.27%/50.72%) NS
Duration of diabetes mellitus (year; mean±SD) 4.95±2.03 7.59±5.49* <0.0001
BMI (mean±SD) 23.53±5.03 25.56±4.44* <0.0001
Regular physical exercise (n) 51 (76.11%) 122 (58.93%)* <0.0001
Family history of diabetes mellitus (n) 19 (28.35%) 104 (50.24%)* <0.0001
Family history of periodontitis (n) 9 (13.43%) 94 (45.41%)* <0.0001
Diabetes mellitus treatment (n)
Diet control
Oral medication
Insulin
35 (52.23%)
28 (41.79%)
04 (5.97%)
26 (12.56%)*
154 (74.39%)*
27 (13.04%)*
<0.0001
<0.0001
<0.0001
Frequency of tooth brushing (n)
≥2 times/day
54 (80.59%) 172 (83.09%) NS
Socio economic status
Low
Middle
High
11 (16.41%)
35 (52.23%)
21 (31.34%)
103 (49.75%)*
37 (17.87%)*
67 (32.36%)*
<0.0001
<0.0001
<0.0001
Diabetic complications
Retinopathy
Nephropathy
Neuropathy
14 (20.89%)
10 (14.92%)
6 (8.95%)
136 (65.7%)*
109 (52.65%)*
70 (33.81%)*
<0.0001
<0.0001
<0.0001
HbA1c (%)
FPG (mmol/L)
PPG (mmol/L)
5.74±1.34
95.29±23.19
112.12±28.81
7.24±2.39*
119.24±48.58*
158.78±71.52*
<0.0001
<0.0001
<0.0001
Tab.1  Patients characteristics for periodontally healthy and chronic periodontitis groups
Variable Low PISA (LP)
?(n = 79)
Middle PISA (MP)
?(n = 68)
High PISA (HP)
?(n = 60)
P
?(LP/MP)
P
?(LP/HP)
P
?(MP/HP)
Age (year; mean±SD) 54.47±8.43 53.89±6.18 53.21±6.47 NS NS NS
Male/female (n) 39/40
(49.36%/50.63%)
33/35
(48.52%/51.47%)
32/28
(53.33%/46.66%)
NS NS NS
Duration of diabetes mellitus (year; mean±SD) 6.94±4.57 8.77±6.83 7.11±4.74 NS NS NS
BMI (mean±SD) 24.04±5.17 26.48±3.69* 28.51±3.62*† <0.0001 0.002 0.002
Regular physical exercise (n) 41 (51.89%) 46 (67.64%) 35 (58.33%) NS NS NS
Family history of diabetes mellitus (n) 24 (30.37%) 34 (50.00%)* 46 (76.66%)*† 0.000 0.000 <0.0001
Family history of periodontitis (n) 31 (39.24%) 26 (38.23%) 37 (61.66%)* NS NS <0.0001
Diabetes mellitus treatment (n)
?Diet control
?Oral medication
?Insulin
10 (12.65%)
61 (77.21%)
8 (10.12%)
8 (11.76%)
51 (75.00%)
9 (13.23%)
8 (13.33%)
42 (70.00%)
10 (16.66%)
NS
NS
NS
NS
NS
NS
NS
NS
NS
Frequency of tooth brushing (n)
?≥2 times/day
64 (81.81%) 57 (83.82%) 51 (85.00%) NS NS NS
Socioeconomic status
?Low
?Middle
?High
37 (46.83%)
9 (11.39%)
33 (41.77%)
31 (45.58%)
13 (19.11%)
24 (35.29%)
35 (58.33%)
15 (25.00%)
10 (16.66%)*†
NS
NS
NS
NS
NS
<0.0001
NS
NS
<0.0001
Diabetic complications
?Retinopathy
?Nephropathy
?Neuropathy
38 (48.10%)
29 (36.70%)
21 (26.58%)
43 (63.23%)
37 (54.41%)
26 (38.23%)
55 (91.66%)*
43 (71.66%)*
23 (38.33%)
NS
NS
NS
<0.0001
<0.0001
NS
NS
NS
NS
Tab.2  Demographic parameters of study subjects (total= 207) by tertiles of mean PISA
Variable Low PISA (n=79)
(LP)
Middle PISA (n=68)
(MP)
High PISA (n=60)
(HP)
P
(LP/MP)
P
(LP/HP)
P
(MP/HP)
HbA1c (%) 6.06±1.59 7.03±1.77* 9.05±2.79*† 0.006 <0.0001 <0.0001
FPG (mmol/L) 101.04±28.81 121.98±48.86* 140.11±59.47* 0.014 <0.0001 0.066
PPG (mmol/L) 129.68±38.08 166.93±82.09* 187.85±78.87* 0.003 <0.0001 0.170
PI 1.48±0.31 1.43±0.37 1.51±0. 24 NS NS NS
Tab.3  Glycemic levels and plaque scores by PISA severity (mean±SD)
Fig.2  Scatter plot of subjects with type 2 diabetes showing, after controlling for age, gender, BMI, SES (high/middle versus low), family history of diabetes, family history of periodontitis, the number of years since diagnosed with diabetes, a positive relationship between the level of HbA1c and PPD 4?6 mm (%) (r = 0.543, P<0.0001) in partial correlation analysis. There was also a significant positive correlation between the levels of HbA1c with PPD≥7 mm (%) (r = 0.678, P<0.0001) and mean PISA (mm2) (r = 0.553, P<0.0001).
Model ?Unstandardized coefficients Standardized coefficients t Sig. ??95% confidence interval for B
B Std. Error Beta Lower bound Upper bound
(Constant) 1.070 1.246 0.859 0.391 −1.387 3.527
PPD mm −0.092 0.444 −0.031 −0.208 0.836 −0.969 0.784
PPD 4–6 mm (%) 0.058 0.011 0.303 5.440 <0.0001* 0.037 0.079
PPD≥7mm (%) 0.223 0.019 0.521 11.687 <0.0001* 0.186 0.261
CAL mm 0.174 0.338 0.061 0.513 0.608 −0.495 0.842
PISA mm2 0.001 0.000 0.194 2.066 0.040* 0.000 0.002
BOP (%) −0.003 0.007 −0.023 −0.421 0.674 −0.015 0.012
Retinopathy −0.080 0.245 −0.017 −0.329 0.743 −0.563 0.403
Nephropathy 0.155 0.247 0.032 0.627 0.531 −0.330 0.643
Neuropathy 0.180 0.208 0.037 0.863 0.389 −0.231 0.590
Tab.4  Results from multiple linear regression analyses (models to predict HbA1c)
Variable Model 1 Model 2 Model 3
95%CI P* SE 95%CI P* SE 95%CI P* SE
PISA median 1.010-1.568 0.04 0.298 0.965-1.491 NS 0.021 1.084-1.674 0.007 0.301
Tab.5  Logistic regression analyses of the association between diabetic complications with PISA (median value)
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