Co-occurrence of Periodontitis and Diabetes-Related Complications

F V Bitencourt; G G Nascimento; S A Costa; A Andersen; A Sandbæk; F R M Leite

doi:10.1177/00220345231179897

Co-occurrence of Periodontitis and Diabetes-Related Complications

J Dent Res. 2023 Sep;102(10):1088-1097. doi: 10.1177/00220345231179897. Epub 2023 Jul 14.

Authors

F V Bitencourt^{1

2}, G G Nascimento^{3

4}, S A Costa⁵, A Andersen², A Sandbæk^{2

6}, F R M Leite^{3

4}

Affiliations

¹ Department of Dentistry and Oral Health, Section for Periodontology, Aarhus University, Aarhus, Denmark.
² Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
³ National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore.
⁴ Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore.
⁵ Graduate Dentistry Program, Federal University of Maranhão, São Luís, Maranhão, Brazil.
⁶ Department of Public Health, Aarhus University, Aarhus, Denmark.

PMID: 37448314
DOI: 10.1177/00220345231179897

Abstract

Periodontitis is a common finding among people with diabetes mellitus (DM) and has been cited as a DM complication. Whether and how periodontitis relates to other diabetes-related complications has yet to be explored. This study aims to examine the clustering of periodontitis with other diabetes-related complications and explore pathways linking diabetes-related complications with common risk factors. Using data from participants with DM across 3 cycles of the National Health and Nutrition Examination Survey (NHANES) (n = 2,429), we modeled direct and indirect pathways from risk factors to diabetes-related complications, a latent construct comprising periodontitis, cardiovascular diseases, proteinuria, and hypertension. Covariates included age, sex, socioeconomic status (SES), smoking, physical activity, healthy diet, alcohol consumption, hemoglobin A1c (HbA1c), dyslipidemia, and body mass index (BMI). Sensitivity analyses were performed considering participants with overweight/obesity and restricting the sample to individuals without DM. Periodontitis clustered with other diabetes complications, forming a latent construct dubbed diabetes-related complications. In NHANES III, higher HbA1c levels and BMI, older age, healthy diet, and regular physical activity were directly associated with the latent variable diabetes-related complications. In addition, a healthy diet and BMI had a total effect on diabetes-related complications. Although sex, smoking, dyslipidemia, and SES demonstrated no direct effect on diabetes-related complications in NHANES III, a direct effect was observed using NHANES 2011-2014 cycles. Sensitivity analysis considering participants with overweight/obesity and without DM showed consistent results. Periodontal tissue breakdown seems to co-occur with multiple diabetes-related complications and may therefore serve as a valuable screening tool for other well-known diabetes-related complications.

Keywords: diabetes; hypertension; noncommunicable diseases; periodontal disease; proteinuria; systemic disease.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Diabetes Complications*
Diabetes Mellitus* / diagnosis
Diabetes Mellitus* / epidemiology
Dyslipidemias* / complications
Dyslipidemias* / epidemiology
Glycated Hemoglobin
Humans
Nutrition Surveys
Obesity
Overweight
Periodontitis* / complications
Periodontitis* / epidemiology

Substances

Glycated Hemoglobin