Oxidative, Inflammatory and Diabetic status in Type-2 Diabetics with Periodontitis

Oxidative stress, demonstrated in periodontitis and type 2 diabetes mellitus (T2DM) independently, may be amplified when the two co-exist. Objective: To determine the impact of periodontitis on oxidative and inflammatory status and metabolic control in T2DM. Methods: 20 Type 2 diabetes patients with periodontitis (DP) (BMI 30±5), 20 age/gender-matched periodontally healthy T2DM controls (DH) (BMI 29±6) and 17 non-diabetic-periodontitis controls (NDP) (BMI 25±2) had full periodontal examinations and fasting plasma samples collected. Oxidative stress was determined by plasma total antioxidant capacity (pTAOC) and protein carbonyl levels; inflammatory status by total/differential white cell counts, fibrinogen and high sensitivity C-reactive protein (hsCRP); diabetic status by lipid profile and by fasting glucose, HbA1c and insulin resistance and secretion (%B) calculated using the HOMA model. Statistical analysis was performed using SPSS. Results: DP and NDP patients were periodontally matched. pTAOC was significantly lower in DP compared to DH (452.6 µM/L verses 522.9µM/L), p=0.047 and carbonyls were higher in the DP group (2.7µM/L verses 1.98µM/L). NDP pTAOC (474.9µM/L) was non-significantly lower than that of the DH group (522.9µM/L). A significant difference was found between diabetic (DP=3.48mM; DH=2.61mM) and non-diabetic groups (ND=1.5mM) for hsCRP (p<0.05). HbA1c levels were higher in DP (8.4±1.5) than in both DH (6.8±1.2) and NDP (5.4±0.2), p>0.001. Fasting glucose was higher in DP (8.6±2.9mmol/L) verses DH (6.8±1.5 mmol/L) and NDP (5.03±0.43), p<0.02. Insulin secretion was lower in DP (37%±20%) than DH (p=0.004). HDL/cholesterol was reduced in DP verses DH (p=0.02) and triglycerides were higher in DP verses NDP (1.99 vs 1.36 mmol/L, p=0.036), p=0.036. Conclusion: Periodontitis is associated with increased oxidative stress in Type 2 DM patients and with compromised glycaemic and lipidaemic control in the groups studied. Type 2 Diabetes is associated with signs of augmented inflammation, when it co-exists with periodontitis.