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
ARTICLE HIGHLIGHTS
Research 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.

Research motivation

Studies regarding this relation and the role of lipoprotein(a) [Lp(a)] and interleukin-6 (IL-6) in these conditions are scarce in the literature. This study assessed the proportion and severity of periodontitis and the correlation between periodontal inflamed surface area (PISA), and clinical attachment loss (CAL) with glycated hemoglobin (HbA1c), serum IL-6 and Lp(a).

Research objectives

(1) To determine and compare the proportion and severity of periodontitis in T2DM subjects with and without DR; (2) To assess the correlation between PISA and HbA1c, serum IL-6, and Lp(a) in T2DM subjects with and without DR; and (3) To assess the correlation between CAL and HbA1c, serum IL-6, and Lp(a) in T2DM subjects with and without DR.

Research methods

The duration of the study was 18 months. In this study, 80 T2DM subjects (40 with DR and 40 without DR) were selected from the diabetic clinic of Department of Internal Medicine, Government Medical College, Calicut. They were divided into two groups based on the presence of DR as follows: Group I- T2DM with DR and Group II- T2DM without DR. Subjects were assessed with a detailed questionnaire regarding their socio-demographic characteristics, medical history, oral hygiene practice, history of diabetes and drug allergy. HbA1c, fasting plasma glucose and postprandial plasma glucose, serum IL-6, and Lp(a) were evaluated. Probing pocket depth, CAL, bleeding on probing, oral hygiene index-simplified, PISA and periodontal disease severity were determined. Diagnosis of DR was done by dilated fundoscopy.

Research results

The proportion of periodontitis in T2DM with DR and in T2DM without DR was 47.5% and 27.5% respectively. Severity of periodontitis, CAL, PISA, serum IL-6 and Lp(a) were higher in T2DM with DR group compared to T2DM without DR group. 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 IL6 (r = 0.651, P < 0.0001); PISA and Lp(a) (r = 0.59, P < 0.001); CAL and IL6 (r = 0.527, P < 0.0001) and CAL and Lp(a) (r = 0.631, P < 0.001) among study subjects.

Research conclusions

The presence of DR may have contributed to the severity of periodontal destruction and periodontitis may have influenced the progression of DR.

Research perspectives

Since a bidirectional link exists between periodontitis and diabetes mellitus, periodontal therapy should be included in the diabetes management. Proper periodontal care can help in improving glycemic control and prevent the progression of DR to some extent. A better understanding of the association between type 2 DR and periodontitis will help to create awareness among the public and to improve their overall quality of life.