Analysis of the correlation between glycemic variability indices and disease severity as well as inflammatory status in patients with type 2 diabetes mellitus and periodontitis.

backgroundThe interaction between type 2 diabetes mellitus (T2DM) and periodontitis is a growing research focus, with glycemic variability potentially playing a critical role in the pathophysiology and severity of periodontal disease in T2DM patients. This study aims to evaluate the association between glycemic variability, inflammatory markers, and the occurrence and severity of periodontitis in patients with T2DM.

methodsA retrospective case-control study included 296 T2DM patients admitted between February 2020 and November 2023. Patients were screened based on demographic and clinical criteria, segregating into non-periodontitis (n = 83) and periodontitis (n = 213) groups. Periodontal status was categorized using American Academy of Periodontology guidelines into non-severe (n = 131) and severe (n = 82) groups. Glycemic variability indices including average blood glucose, coefficient of variation (CV), standard deviation (SD), and mean amplitude of glycemic excursions (MAGE) were measured using continuous glucose monitoring systems. Inflammatory markers, including interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), were quantified in gingival crevicular fluid (GCF) using enzyme-linked immunosorbent assay. Statistical analyses included multivariate logistic regression and correlation analyses.

resultsIncreased glycemic variability was significantly correlated with the presence and severity of periodontitis (P < 0.05). T2DM patients with periodontitis exhibited higher levels of inflammatory markers IL-1, IL-6, and TNF-α. Multivariate logistic regression identified SD (OR = 2.046, 95% CI: 1.324-3.162), CV (OR = 1.054, 95% CI: 1.008-1.102), and MAGE (OR = 1.368, 95% CI: 1.097-1.706) as significant predictors for periodontitis occurrence in T2DM patients. IL-6 and TNF-α showed strong interrelationships and correlations with glycemic indices.

conclusionGlycemic variability significantly influences the occurrence and severity of periodontitis in T2DM patients. This relationship is mediated through enhanced inflammatory responses, suggesting potential pathways linking glycemic instability to periodontal deterioration. The findings underscore the importance of glycemic control in managing periodontal health in T2DM, proposing glycemic variability as a target for therapeutic interventions to mitigate the risk and progression of periodontitis.