Observational Study
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World J Diabetes. Apr 15, 2024; 15(4): 686-696
Published online Apr 15, 2024. doi: 10.4239/wjd.v15.i4.686
Correlation of periodontal inflamed surface area with glycated hemoglobin, interleukin-6 and lipoprotein(a) in type 2 diabetes with retinopathy
Nusreen Jamal Thazhe Poyil, Rosamma Joseph Vadakkekuttical, Chandni Radhakrishnan
Nusreen Jamal Thazhe Poyil, Rosamma Joseph Vadakkekuttical, Department of Periodontics, Government Dental College (Affiliated to Kerala University of Health Sciences), Calicut 673008, Kerala, India
Chandni Radhakrishnan, Department of Medicine, Government Medical College (Affiliated to Kerala University of Health Sciences), Calicut 673008, Kerala, India
Author contributions: All the authors in this study have contributed significantly and by keeping the latest guidelines by international committee of medical journal editors; Vadakkekuttical RJ has contributed to conception, study design, data analysis, intellectual content, interpretation of data and final approval of the manuscript; Thazhe Poyil NJ has contributed to study design, data analysis, interpretation of data and manuscript drafting and final approval of the manuscript; Radhakrishnan C has contributed to study design, interpretation of data, intellectual content, and final approval of the manuscript; all authors approved the final version to be published.
Institutional review board statement: Institutional Review Board Statement: The study was reviewed and approved by the Institutional ethics committee Government Dental College Kozhikode on 14 -11-2019 (IEC no: 149/2019/DCC dated 14-11-2019).
Informed consent statement: All the study participants were explained about the study and informed written consent was obtained in the regional language prior to study enrollment of each subject and the documents are kept under safe custody in the department.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest in this study. This study was supported by personnel funds of the authors.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rosamma Joseph Vadakkekuttical, MDS, Professor, Department of Periodontics, Government Dental College (Affiliated to Kerala University of Health Sciences), Govt. Medical College Campus, Calicut 673008, Kerala, India. drrosammajoseph@gmail.com
Received: December 20, 2023
Peer-review started: December 20, 2023
First decision: January 10, 2024
Revised: January 19, 2024
Accepted: March 1, 2024
Article in press: March 1, 2024
Published online: April 15, 2024
Abstract
BACKGROUND

The two-way relationship between periodontitis and type 2 diabetes mellitus (T2DM) is well established. Prolonged hyperglycemia contributes to increased periodontal destruction and severe periodontitis, accentuating diabetic complications. An inflammatory link exists between diabetic retinopathy (DR) and periodontitis, but the studies regarding this association and the role of lipoprotein(a) [Lp(a)] and interleukin-6 (IL-6) in these conditions are scarce in the literature.

AIM

To determine the correlation of periodontal inflamed surface area (PISA) with glycated Hb (HbA1c), serum IL-6 and Lp(a) in T2DM subjects with retinopathy.

METHODS

This cross-sectional study comprised 40 T2DM subjects with DR and 40 T2DM subjects without DR. All subjects were assessed for periodontal parameters [bleeding on probing (BOP), probing pocket depth, clinical attachment loss (CAL), oral hygiene index-simplified, plaque index (PI) and PISA], and systemic parameters [HbA1c, fasting plasma glucose and postprandial plasma glucose, fasting lipid profile, serum IL-6 and serum Lp(a)].

RESULTS

The proportion of periodontitis in T2DM with and without DR was 47.5% and 27.5% respectively. Severity of periodontitis, CAL, PISA, IL-6 and Lp(a) were higher in T2DM with DR group compared to T2DM without DR group. Sig-nificant difference was observed in the mean percentage of sites with BOP between T2DM with DR (69%) and T2DM without DR (41%), but there was no significant difference in PI (P > 0.05). HbA1c was positively correlated with CAL (r = 0.351, P = 0.001), and PISA (r = 0.393, P ≤ 0.001) in study subjects. A positive correlation was found between PISA and IL-6 (r = 0.651, P < 0.0001); PISA and Lp(a) (r = 0.59, P < 0.001); CAL and IL-6 (r = 0.527, P < 0.0001) and CAL and Lp(a) (r = 0.631, P < 0.001) among study subjects.

CONCLUSION

Despite both groups having poor glycemic control and comparable plaque scores, the periodontal parameters were higher in DR as compared to T2DM without DR. Since a bidirectional link exists between periodontitis and DM, the presence of DR may have contributed to the severity of periodontal destruction and periodontitis may have influenced the progression of DR.

Keywords: Type 2 diabetes mellitus, Periodontitis, Periodontal inflamed surface Area, Glycated Hb, Diabetic retinopathy

Core Tip: Periodontal inflamed surface area (PISA) estimates the periodontal inflammatory burden. Prolonged hyperglycemia contributes to increased periodontal destruction and accentuates diabetic complications. An inflammatory link may exist between diabetic retinopathy (DR) and periodontitis. This study assessed correlation between PISA with glycated Hb (HbA1c), interleukin-6 (IL-6) and lipoprotein(a) [Lp(a)] in type 2 diabetes mellitus (T2DM) subjects with and without DR. Significant positive correlation between PISA with HbA1C, IL-6 and Lp(a) were observed. Proportion and severity of periodontitis, PISA, IL-6 and Lp(a) were higher in DR compared to T2DM without DR. Presence of DR may have contributed to the severity of periodontitis and periodontitis may have influenced the progression of DR.