Microvascular Diabetes Complications Linked to Moderate/Severe Gum Disease

Certain diabetes complications were linked to moderate and severe periodontitis, a cross-sectional analysis using Danish population-based data suggested.

Among nearly 16,000 patients with type 2 diabetes, adjusted models showed that diabetic neuropathy (OR 1.36, 95% CI 1.14-1.63) and retinopathy (OR 1.21, 95% CI 1.03-1.43) were significantly associated with moderate/severe periodontitis, reported Fernando Valentim Bitencourt, a PhD student at Aarhus University Hospital in Denmark, and colleagues in the Journal of Dental Research.

In addition, the coexistence of these microvascular complications increased the odds of moderate/severe periodontitis (OR 1.51, 95% CI 1.23-1.85), as shown in the models adjusted for potential confounders like sociodemographic factors, lifestyle behaviors, and health conditions, Bitencourt said at the European Association for the Study of Diabetes (EASD) annual meeting in Madrid, where the findings were also presented.

“When diabetes is poorly controlled, high blood sugar levels can lead to inflammation, which, over time, can affect the eyes, leading to retinopathy, or the nerves in the feet, causing neuropathy, or the gums, contributing to the development of severe periodontitis,” Bitencourt explained. “Importantly, the role of inflammation means that periodontitis might not only serve as a marker for oral health issues, but could also help identify individuals with a higher systemic inflammatory burden, who are therefore at greater risk of diabetes-associated microvascular complications.”

A chronic multifactorial inflammatory disease, periodontitis can lead to the destruction of tissue around the tooth and can cause tooth loss if not treated. It’s a relatively common condition, but prevalence is much higher in those with diabetes than those without.

Tooth loss can impact many essential functions like chewing and speaking, as well as self-esteem, Bitencourt said. “As a result, periodontitis can significantly reduce a person’s quality of life, leading to difficulties with nutrition, communication, and social interactions.”

“We need to better integrate periodontitis into prevention and management strategies when we think about diabetes complications,” he noted. “We need to integrate better general endodontal care and target their common risk factors.”

The researchers also looked at how the presence of dyslipidemia affected the relationship between microvascular complications and periodontitis, finding that the risk for periodontitis was greater with each microvascular complication in people with type 2 diabetes and dyslipidemia:

• Neuropathy: OR 1.40 (95% CI 1.19-1.65)
• Retinopathy: OR 1.43 (95% CI 1.22-1.68)
• Both: OR 1.47 (95% CI 1.12-1.94)

None of the microvascular complications remained significantly linked with periodontitis in people without dyslipidemia, despite a small trend towards a relationship:

• Neuropathy: OR 1.23 (95% CI 0.99-1.53)
• Retinopathy: OR 1.13 (95% CI 0.94-1.37)
• Both: OR 1.33 (95% CI 0.95-1.87)

“For dentists in particular, this means recognizing that patients with type 2 diabetes and moderate/severe periodontitis, especially those with dyslipidemia, may be at a higher risk for microvascular complications such as neuropathy and retinopathy,” Bitencourt said. “Dentists should consider recommending that these patients be screened for microvascular complications.”

“By working together, healthcare providers can help ensure that patients with type 2 diabetes, especially those who are at an elevated risk of diabetes complications, receive more comprehensive oral healthcare — potentially improving both their oral and overall health,” he added.

This cross-sectional analysis used population-based data from the Health in Central Denmark, collected through electronic questionnaires distributed from November 2020 to February 2021, combined with national registers and laboratory data.

Only those with type 2 diabetes identified using a validated algorithm were included, which used hospital diagnoses, purchases of glucose-lowering medications, attendance of diabetes-specific podiatry services, and HbA1c level.

Of the 15,922 patients included in the study, mean age was 63.7, and 51.7% were men.

For this study, dyslipidemia was defined as triglyceride levels >150 mg/dL, total cholesterol levels >200 mg/dL, low-density lipoprotein cholesterol levels >100 mg/dL, and high-density lipoprotein cholesterol levels <40 mg/dL in men and <50 mg/dL for women.

Periodontitis and microvascular complications were self-reported, which was a limitation to the study. The researchers also noted that a clinical assessment may have provided “a more accurate assessment” of the extent of diabetic neuropathy and retinopathy among those with diabetes.

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