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    Treatment of periodontitis reduces systemic inflammation in type 2 diabetes. Preshaw Philip M,Taylor John J,Jaedicke Katrin M,De Jager Marko,Bikker Jan Willem,Selten Wieke,Bissett Susan M,Whall Kerry M,van de Merwe Rachel,Areibi Aisha,Jitprasertwong Paiboon,Al-Shahwani Rana,Weaver Jolanta,Taylor Roy,Wassall Rebecca R Journal of clinical periodontology AIMS:To assess the impact of periodontal treatment on systemic inflammation in type 2 diabetes. MATERIALS AND METHODS:Adults with type 2 diabetes (n = 83) and without diabetes (controls, n = 75) were recruited, and participants with periodontitis received periodontal treatment and 12 months' follow-up. Biomarkers for periodontal inflammation (gingival crevicular fluid interleukin-6, tumour necrosis factor-α, interleukin-1β, interferon-γ, matrix metalloproteinase-8, matrix metalloproteinase-9, adiponectin) and serum markers of inflammation and diabetes control (glycated haemoglobin, high sensitivity C-reactive protein, interleukin-6, tumour necrosis factor-α, interleukin-1β, interferon-γ, leptin, adiponectin) were measured. Structural equation modelling was used to evaluate periodontal treatment effects on oral and systemic inflammation. RESULTS:Periodontal treatment resulted in significant improvements in clinical status and reductions in gingival crevicular fluid biomarkers from baseline to month 12. Structural equation modelling identified that, at baseline, individuals with diabetes and periodontitis had significantly higher systemic inflammation than non-diabetic controls with periodontitis (Δ = 0.20, p = .002), with no significant differences between groups for oral inflammation. There was a greater reduction in systemic inflammation following periodontal treatment in individuals with diabetes and periodontitis compared to those with periodontitis but not diabetes (Δ = -0.25, p = .01). CONCLUSIONS:Diabetes and periodontitis together appear to increase systemic inflammation, with evidence of reductions following periodontal treatment. 10.1111/jcpe.13274
    Epidemiologic relationship between periodontitis and type 2 diabetes mellitus. Wu Chen-Zhou,Yuan Yi-Hang,Liu Hang-Hang,Li Shen-Sui,Zhang Bo-Wen,Chen Wen,An Zi-Jian,Chen Si-Yu,Wu Yong-Zhi,Han Bo,Li Chun-Jie,Li Long-Jiang BMC oral health BACKGROUND:To systematically review the epidemiologic relationship between periodontitis and type 2 diabetes mellitus (T2DM). METHODS:Four electronic databases were searched up until December 2018. The manual search included the reference lists of the included studies and relevant journals. Observational studies evaluating the relationship between T2DM and periodontitis were included. Meta-analyses were conducted using STATA. RESULTS:A total of 53 observational studies were included. The Adjusted T2DM prevalence was significantly higher in periodontitis patients (OR = 4.04, p = 0.000), and vice versa (OR = 1.58, p = 0.000). T2DM patients had significantly worse periodontal status, as reflected in a 0.61 mm deeper periodontal pocket, a 0.89 mm higher attachment loss and approximately 2 more lost teeth (all p = 0.000), than those without T2DM. The results of the cohort studies found that T2DM could elevate the risk of developing periodontitis by 34% (p = 0.002). The glycemic control of T2DM patients might result in different periodontitis outcomes. Severe periodontitis increased the incidence of T2DM by 53% (p = 0.000), and this result was stable. In contrast, the impact of mild periodontitis on T2DM incidence (RR = 1.28, p = 0.007) was less robust. CONCLUSIONS:There is an evident bidirectional relationship between T2DM and periodontitis. Further well-designed cohort studies are needed to confirm this finding. Our results suggest that both dentists and physicians need to be aware of the strong connection between periodontitis and T2DM. Controlling these two diseases might help prevent each other's incidence. 10.1186/s12903-020-01180-w
    Periodontitis and insulin resistance: casual or causal relationship? Gurav Abhijit N Diabetes & metabolism journal Insulin resistance (IR) is now considered as a chronic and low level inflammatory condition. It is closely related to altered glucose tolerance, hypertriglyceridemia, abdominal obesity, and coronary heart disease. IR is accompanied by the increase in the levels of inflammatory cytokines like interleukin-1 and 6, tumor necrosis factor-α. These inflammatory cytokines also play a crucial part in pathogenesis and progression of insulin resistance. Periodontitis is the commonest of oral diseases, affecting tooth investing tissues. Pro-inflammatory cytokines are released in the disease process of periodontitis. Periodontitis can be attributed with exacerbation of IR. Data in the literature supports a "two way relationship" between diabetes and periodontitis. Periodontitis is asymptomatic in the initial stages of disease process and it often escapes diagnosis. This review presents the blurred nexus between periodontitis and IR, underlining the pathophysiology of the insidious link. The knowledge of the association between periodontitis and IR can be valuable in planning effectual treatment modalities for subjects with altered glucose homeostasis and diabetics. Presently, the studies supporting this association are miniscule. Further studies are mandatory to substantiate the role of periodontitis in the deterioration of IR. 10.4093/dmj.2012.36.6.404
    Association between insulin resistance and periodontitis in Korean adults. Lim Sang Gyu,Han Kyungdo,Kim Hyun-Ah,Pyo Sung Woon,Cho Young-Sik,Kim Kyung-Soo,Yim Hyeon Woo,Lee Won-Chul,Park Yong Gyu,Park Yong-Moon Journal of clinical periodontology OBJECTIVE:Recent studies have proposed an association between periodontitis and metabolic abnormalities. We investigated the association between insulin resistance and periodontitis among Korean adults. METHODS:A cross-sectional analysis was conducted using the Korea National Health and Nutrition Examination Survey 2008-2010. A total of 16,720 non-diabetic subjects over 18 years old were evaluated (7060 men and 9660 women). Periodontal status was assessed by the Community Periodontal Index. Insulin resistance was measured using the homeostasis model assessment of insulin resistance (HOMA-IR). Participants in the highest and lowest quartile of HOMA-IR were defined as insulin-resistant and insulin-sensitive respectively. RESULTS:The prevalence of periodontitis increased significantly with higher HOMA-IR quartiles in post-menopausal women (p for linear association = 0.019). Among post-menopausal women, participants in the highest quartile of HOMA-IR were significantly more likely to have periodontitis compared to those in the lowest quartile [adjusted odds ratio (OR), 1.47; 95% confidence interval (CI), 1.07-2.01]. Moreover, obese post-menopausal women showed an increased association between insulin resistance and periodontitis (adjusted OR, 1.92; 95% CI,1.29-2.87). However, this association was not found in men or pre-menopausal women. CONCLUSIONS:Our results suggest that insulin resistance may be associated with periodontitis, especially when combined with obesity, among post-menopausal women in Korea. 10.1111/jcpe.12196
    Severe Periodontitis Is Associated with Insulin Resistance in Non-abdominal Obese Adults. Song In-Seok,Han Kyungdo,Park Yong-Moon,Ji Suk,Jun Sang Ho,Ryu Jae-Jun,Park Jun-Beom The Journal of clinical endocrinology and metabolism CONTEXT:We hypothesized that insulin resistance, even with normal body weight (body mass index or waist circumference), can aggravate periodontitis severity. OBJECTIVE:We investigated the associations between diabetes, insulin resistance, and severe periodontitis. DESIGN:Among 29 235 total participants, 5690 subjects aged ≥ 30 y who had periodontal disease with community periodontal index (CPI) of 3 or 4 were selected for this study. PARTICIPANTS:Data were derived from the 2008-2010 Korea National Health and Nutrition Examination Survey. RESULTS:Patients diagnosed with type 2 diabetes were more likely to have severe periodontitis (CPI 4) compared with patients with normal glucose tolerance or impaired fasting glucose (P < .001). Subjects with severe periodontitis had significantly higher prevalence of abdominal obesity, serum triglycerides, and insulin resistance (P values of .012, <.001, and .003, respectively). The odds ratios (ORs) for prevalence of severe periodontitis were significantly increased from normal glucose tolerance and impaired fasting glucose (OR = 1.32; 95% confidence interval, 1.06-1.64) to type 2 diabetes (OR = 1.5; 95% CI, 1.11-2.02), after adjusting for potential confounders (P for trend = .003). The prevalence of severe periodontitis increased significantly with increasing insulin resistance (P for trend = .04) in nondiabetic individuals. Furthermore, insulin-resistant individuals with normal waist circumference showed significantly higher odds of severe periodontitis (OR = 1.47; 95% CI, 1.16-1.87) than did insulin-sensitive individuals with normal waist circumference. CONCLUSIONS:Non-abdominally obese subjects with insulin resistance were more likely to have severe periodontitis. Insulin resistance can be considered an independent risk factor of periodontal disease in normal weight population defined by abdominal obesity. 10.1210/jc.2016-2061