Diabetes Elevates Levels of Systemic Inflammation

Systemic inflammation is believed to play an important role in the development of type 2 diabetes. Evidence points to an increased cytokine response in type 2 diabetes, especially the pro-inflammatory proteins/cytokines (i.e. IL-1 beta, IL-6, and tumor necrosis factor-alpha). Tumor necrosis factor-α (TNF-α) may play an important role in insulin resistance (1). Porphyromonas gingivalis, one of the microorganisms responsible for this infection, is able to invade endothelial cells and is a potent signal for monocyte and macrophage activation.

Once established in the diabetic host, chronic periodontal infections complicate diabetes control and increases the occurrence and severity of microvascular and macrovascular complications (2). The medical literature supports the idea that treatment of chronic oral infections is essential in people with diabetes. Antimicrobial therapy significantly reduced the number of microorganisms in periodontal pockets. The results indicate that anti-infectious treatment is effective in improving metabolic control in diabetics, possibly through reduced serum TNF-α and improved insulin resistance (3).

Physicians managing diabetic conditions in their patients should consider assessment of oral infection status to be fundamental for appropriate treatment decisions.

1- Iwamoto Y, Nishimura F., The Effect of Antimicrobial Periodontal Treatment on Circulating Tumor Necrosis Factor-Alpha and Glycated Hemoglobin Level in Patients With Type 2 Diabetes. J Periodontol 2001;72:774-778.
2- Grossi SG. Treatment of Periodontal Disease and Control of Diabetes: An Assessment of the Evidence and Need for Future Research. Annals of Periodontology 2001, Vol. 6, No. 1, Pages 138-145.
3- Ibid, Iwamoto

Gum Disease is Strong Predictor of Mortality in Diabetic Patients

Dentists and physicians have long understood that diabetes is a complicating factor for gum disease. New research is now showing that the opposite is also true, that the existence of chronic gum infections can seriously impact the control of diabetes (1). Periodontal disease is more severe and occurs with higher frequency in diabetic patients (2).

Furthermore, periodontal disease contributes to increased mortality associated with diabetes. Research has shown that chronic oral infections are a strong predictor of death from cardiorenal disease in a diabetic population.

Researchers from the National Institute of Diabetes and Kidney Disease studied 628 Pima Indians with type 2 diabetes. After adjusting for factors such as duration of diabetes, hypertension, tobacco use and other factors, they conclude that periodontal disease is strongly predictive of mortality from ischemic heart disease and diabetic nephropathy (3). Those with severe periodontal disease had a 28.4 % death rate and those with no or little periodontal disease had a 3.7% death rate (4). This represents an almost 700% increase in death comparing diabetics with and without advanced gum disease.

Periodontal disease in people with diabetes makes them twice as likely to die from kidney failure or heart disease (5). When the gums pull far away from the teeth due to severe gum disease, harmful bacteria and bacterial by-products (i.e. lipopolysaccharides, endotoxins, etc.) from the mouth are allowed to enter the bloodstream, affecting these organs directly and through the effects of pro-inflammatory mediators.

Prudent health care dictates that dentists and physicians recognize both the direct and indirect relationships of these conditions, and that every effort is made to obtain control of periodontal gum tissues which will allow better medical management of diabetes and renal disease.
- 1. Soskolne WA, Klinger A, et. al., The Relationship Between Periodontal Diseases and Diabetes: An Overview, Annals of Periodontology 2001.6.1.91.
-2. www.diabetes.niddk.nih.gov/dm/pubs/america/pdf/chapter23.pdf
-3. Jan 2005 ADA News Release; http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=1219
-4. Saremi A, Nelson RG, et.al., Periodontal Disease and Mortality in Type 2 Diabetes, Diabetes Care, Vol 28, No.1, Jan 2005. p27-32.
-5. 10/03 ADA News Release, Jeffcoat M.http://www.ada.org/public/media/releases/0310_release07.asp