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Periodontitis Associated with Developments of Type 2 Diabetes and its Complications - Oral Disease Treatment can Help Control High Glycemic Levels
FOR IMMEDIATE RELEASE SAN FRANCISCO, CA (June 6, 2008) -- Critical links between periodontal (gum) disease and the development of type 2 diabetes, as well as the development and progression of its complications, were reported here today in the first ever symposium presented by dentists to diabetes experts at the American Diabetes Association's Annual Scientific Sessions at its 68th such event. "One of the many complications of diabetes is a greater risk for periodontal disease,"said Maria E. Ryan, DDS, PhD, Professor of Oral Biology and Pathology, and Director of Clinical Research, School of Dental Medicine, Stony Brook University, New York, in a recent interview. "If you have this oral infection and inflammation, as with any infection, it's much more difficult to control blood glucose levels." Intensive periodontitis treatment significantly reduces levels of A1C, a measure of glucose control over the prior two to three months. These links between oral and systemic health may start even before clinical diabetes begins. "We have found evidence that the severity of periodontal disease is associated with higher levels of insulin resistance, often a precursor of type 2 diabetes, as well as with higher levels of A1C, a measure of poor glycemic control of diabetes," she said. The importance of these findings were emphasized by her colleague, George W. Taylor, DrPH, DMD, Associate Professor of Dentistry, Schools of Dentistry and Public Health, University of Michigan. "Several recent studies have shown that having periodontal disease makes those with type 2 diabetes more likely to develop worsened glycemic control and puts them at much greater risk of end-stage kidney disease and death," he reported.
Nearly 21 million Americans have diabetes, a group of serious diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin. Diabetes can lead to severely debilitating or fatal complications, such as heart disease, blindness, kidney disease, and amputation. It is the fifth leading cause of death by disease in the U.S. Type 2 occurs mainly in adults who are overweight and ages 40 and older. Periodontal (gum) disease is an infection and chronic inflammatory disease of the tissues surrounding and supporting the teeth. It is a major cause of tooth loss in adults. In periodontitis, unremoved plaque hardens into calculus (tartar), gums gradually begin to pull away from the teeth, and pockets form between the teeth and gums. However, people often do not know they have periodontal disease because it is usually painless. Periodontitis Associated with Insulin Resistance and Diabetes Severity "In an analysis of the National Health and Nutrition Examination Survey of the U.S. population data from 1988-94, we recently found that people with periodontal disease were twice as likely to have insulin resistance than those without such disease,"said Dr. Taylor. This result was found after controlling for other characteristics that would be associated with insulin resistance, such as obesity, lipids, exercise, and other markers of inflammation, such as CRP, and whether or not they had diabetes. In an unpublished study at the General Clinical Research Center at Stony Brook University, a group of individuals who were by one measure – RD values (a measure of glucose uptake and insulin sensitivity) -- insulin resistant, and likely had pre-diabetes, also had their oral health assessed. Their degree of insulin resistance directly correlated with the severity of their periodontal disease.
The presence of the IL-1 polymorphism fits with one theory of how periodontitis worsens glycemic control in type 2 diabetes.
Periodontitis Associated with Diabetes Complications Dr. Taylor reported on studies at the University of Michigan and elsewhere demonstrating the association between periodontitis and the complications of type 2 diabetes.
Studies of Pima Indians published by others have shown a higher risk of diabetes complications in those with periodontal disease. For example, one showed that residents of the Gila River Indian Community with severe periodontal disease were at more than three times the risk of death due to diabetic nephropathy or ischemic heart disease than those with no, mild, or moderate periodontal disease over 11 years. Periodontal Treatment Can Improve Diabetes Control
"We recently published a randomized, placebo-controlled, 30-patient study done at the General Clinical Research Center at Stony Brook University showing that a sub-antimicrobial dose of doxycycline, during and after root planing, as part of a 9-month course of treatment, significantly reduced A1C by 1% and also reduced proteinuria, a marker of diabetic kidney disease, and CRP, a marker of inflammation," said Dr. Ryan. "It also significantly reduced pocket depths associated with periodontitis and enabled gains in clinical attachment, while reducing signs of inflammation, such as bleeding upon probing or brushing." Two confirmatory 3-month studies of this program developed at Stony Brook have been conducted, at Columbia University and Buffalo University with 150 patients, and presented at International Association for Dental Research meetings.
The American Diabetes Association is the nation's leading voluntary health organization supporting diabetes research, information and advocacy. Founded in 1940, the Association has offices in every region of the country, providing services to hundreds of communities. For more information, please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit www.diabetes.org. Information from both these sources is available in English and Spanish. Symposium, Friday, 4:15 pm NOTE TO EDITOR: |
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