Evaluation of Periodontal Health in Diabetic Patients: Influence of Glycemic Control and Diabetes Duration Using the Community Periodontal Index – A Longitudinal Study

Periodontal Health in Diabetes

Authors

  • Amira Shahid Department of Operative Dentistry, University Medical & Dental College, Faisalabad
  • Shahid Adil Khalid Department of Prosthodontics, University College of Dentistry, University of Lahore
  • Maliha Muneer Department of Operative Dentistry, PMC Dental Institute Faisalabad Medical University Faisalabad
  • Nida Khan Department of Community Dentistry, University Medical and Dental College, Faisalabad
  • Sarosh Iqbal Department of Oral Biology, University Medical and Dental College, Faisalabad
  • Noor-ul-Huda Department of Periodontics, University College of Dentistry, University of Lahore

DOI:

https://doi.org/10.70384/jlmdc.v2i01.70

Keywords:

Diabetes mellitus, Glycated hemoglobin A, Community Periodontal Index (CPI), Periodontal disease, Longitudinal study

Abstract

Background: Diabetes is a long-term metabolic disease with consequences for periodontal health. However, various studies have established a link between diabetes and periodontal health. In this regard very limited research has been done to investigate the impact of duration of diabetes and glycemic index on periodontal health.

Objective: To evaluate glycemic control (HbA1c levels) and diabetes duration on periodontal health using the Community Periodontal Index (CPI).

Methods: The duration of the study was one year and six months after the approval of synopsis from ethical review board. Based on their glycemic control, 225 diabetic patients were split into three groups: effectively controlled (HbA1c <7%), mildly controlled (HbA1c between 7 and 9%), and inadequately controlled (HbA1c >9%). Periodontal health assessment was performed using the CPI at three time points: baseline, six months, and twelve months.

Results: The study sample was 225 participants. The severity of periodontal disease was higher in diabetic patients with poor glycemic control. Over 12 months, CPI of the poorly controlled group increased to 85%, while the mildly controlled group increased to 55%, and the well-controlled group increased to 30%. A significant correlation was found between HbA1c levels and CPI scores (r=0.72, p<0.001), and between diabetes duration and CPI scores (r=0.68, p<0.001).

Conclusion: The present study suggests a significant effect of glycemic control (HbA1c levels) and diabetes duration on periodontal health assessed by using the Community Periodontal Index (CPI).

References

1. Deheriya M, Bhargava A, Pippal D, Ahirwar A. Assessment of periodontal status in adults with diabetes mellitus. Int J Res Med Sci [Internet]. 2020. [cited 2025 Apr. 10];8(11):3891-3898. doi: 10.18203/2320-6012.ijrms20204430.

2. Nazir MA. Prevalence of periodontal disease, Its association with systemic diseases and prevention. Int J Health Sci. 2017;11(2):72-80. PMCID: PMC5426403 PMID: 28539867.

3. Chee B, Park B, Bartold PM. Periodontitis and type II diabetes: a two-way relationship. Int J Evid Based Healthc. 2013;11(4):317–329. doi: 10.1111/1744- 1609.12038.

4. Chiu SY, Lai H, Yen AM, Fann JC, Chen LS, Chen HH. Temporal sequence of the bidirectional relationship between hyperglycemia and periodontal Diabetes disease: a community-based study of 5,885 Taiwanese aged 35–44 years (KCIS No. 32). Acta Diabetol. 2015;52(1):123–131. doi: 10.1007/s0059- 2-014-0612-0.

5. Verhulst MJ, Loos BG, Gerdes VE, Teeuw WJ. Evaluating all potential oral complications of diabetes mellitus. Front Endocrinol (Lausanne). 2019;10(2):56-61. doi: 10.3389/fendo.2019.00056.

6. Mariyum S, Naheed R, Anwar Z, Iqbal A, Mariyum K, Khalil ZUR. A comparative study of periodontal disease index (PDI) scores in type-2 diabetics and non-diabetics. J Gandhara Med Dent Sci. 2022;9(2):55-59. doi: 10.37762/jgmds.9-2.245.

7. Costa R, Ríos-Carrasco B, Monteiro L, López-Jarana P, Carneiro F, Relvas M. Association between type 1 diabetes mellitus and periodontal diseases. J Clin Med. 2023;12(03):1–25. doi: 10.3390/jcm12031147.

8. Romano F, Perotto S, Mohamed SEO, Bernardi S, Giraudi M, Caropreso P, et al. Bidirectional association between metabolic control in type-2 diabetes mellitus and periodontitis inflammatory burden: a cross-sectional study in an Italian population. J Clin Med. 2021;10(08):1787. doi: 10.3390/jcm10081787.

9. Costa FO, Miranda Cota LO, Pereira Lages EJ, Soares Dutra Oliveira AM, Dutra Oliveira PA, Cyrino RM, et al. Progression of periodontitis and tooth loss associated with glycemic control in individuals undergoing periodontal maintenance therapy: a 5- y e a r f o l l o w - u p st u d y. J P e ri o d o n t o l . 2 0 1 3 ; 8 4 ( 0 5 ): 5 9 5 – 6 0 5 . d o i : 1 0 . 1 9 0 2 /- jop.2012.120255.

10. Adeniyi OV, Yogeswaran P, Longo-Mbenza B, TerGoon D, Ajayi AI. Cross-sectional study of patients with type 2diabetes in OR Tambo district, South Africa. BMJ Open.2016;6(7):e01087581. doi: 10.1136/bmjopen-2015-010875.

11. Aiuto F, Gable D, Syed Z, Allen Y, Wanyonyi KL, White S, et al. Evidence summary: the relationship between oral diseases and diabetes. Br Dent J.2017;22(2):944-948.doi: 10.1038/sj.bdj.2017.544.

12. Akram Z, Alqahtani F, Alqahtani M, Al-Kheraif AA, Javed F. Levels of advanced glycation end products in gingival crevicular fluid of chronic periodontitis patients with and without type-2diabetes mellitus. J Pe ri o d o n t o l. 2 0 2 0 ; 9 1 ( 3 ): 3 9 6 - 4 0 2 . d o i: 10.1002/JPER.19-0209.

13. Mahtani AA, Jacob C, Lakshmanan R. Prevalence of diabetes among patients and the assessment of the awareness of the bidirectional relation between diabetes and periodontal disease. J Family Med Prim Care. 2020;9(6):2774-2780. doi:10.4103/jfmpc.jfmpc_63_20.

14. Harsas NA, Lessang R, Soeroso Y, Putri GA. Periodontal status differences between chronic periodontitis patient with and without type2 diabetes mellitus. J Int Dent Medical Res. 2019; 12(1), 175-180.

15. Lutfiyya MN, Gross AJ, Soffe B. Dental care utilization: examining the associations between health services deficits and not having a dental visit in past 12 months. BMC Public Health. 2019;19:265- 269. doi: 10.1186/s12889-019-6590-y.

16. Miguel-Infante A, Martinez-Huedo MA, MoraZamorano E, Hernandez-Barrera V, Jimenez-Trujillo I, Burgos-Lunar C, et al. Periodontal disease in adults with diabetes, prevalence and risk factors-results of an observational study. Int J Clin Pract. 2019;73(3): e13294-13298. doi: 10.1111/ijcp.13294.

17. Zheng M, Wang C, Ali A, Shih YA, Xie Q, Guo C. Prevalence of periodontitis in people clinically diagnosed with diabetes mellitus: a meta-analysis of e p i d emi o l o g i c st u d i e s. Ac t a Di a b e t o l. 2021;58(10):1307-1327. doi: 10.1007/s00592-021- 01738-2.

18. Adnan M, Aasim M. Prevalence of Type 2 Diabetes Mellitus in Adult Population of Pakistan: A MetaAnalysis of Prospective Cross Sectional Surveys. An n Gl o b He a l t h . 2 0 2 0 ; 8 6 ( 1 ): 7 . d o i : 10.5334/aogh.2679.

19. Stoicescu M, Calniceanu H, Țig I, Nemeth S, Tent A, Popa A, et al. Significant aspects and correlation between glycemic control and generalized chronic periodontitis in type 2 diabetes mellitus patients. Exp Ther Med. 2021;22(1):671. doi: 10.3892/- etm.2021.10103.

20. Wu CZ, Yuan YH, Liu HH, Li SS, Zhang BW, Chen W et al. Epidemiologic relationship between periodontitis and type 2 diabetes mellitus. BMC Oral Health. 2020;20(1):204. doi: 10.1186/s12903-020- 01180-w.

21. Nabila S, Choi J, Kim JE, Hahn S, Hwang IK, Kim TI, et al. Bidirectional associations between periodontal disease and systemic diseases: a nationwide population-based study in Korea. Sci Rep. 2023;13(1):14078. doi: 10.1038/s41598-023-41009-4.

22. Chuang SF, Sung JM, Kuo SC, Huanf JJ, Lee SY. Oral and dental manifestations in diabetic and nondiabetic uremic patients receiving hemodialysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2 0 1 8 ; 9 9 ( 6 ) : 6 8 9 - 6 9 5 . d o i : 1 0 . 1 0 1 6 / - j.tripleo.2004.06.078.

23. Santonocito S, Polizzi A, Marchetti E, Dalessandri D, Migliorati M, Lupi SM, et al. Impact of Periodontitis on Glycemic Control and Metabolic Status in Diabetes Patients: Current Knowledge on Early Disease Markers and Therapeutic Perspectives. Mediators Inflamm. 2022;2022:4955277. doi: 10.1155/2022/4955277.

24. Chen YF, Zhan Q, Wu CZ, Yuan YH, Chen W, Yu FY, et al. Baseline HbA1c Level Influences the Effect of Periodontal Therapy on Glycemic Control in People with Type 2 Diabetes and Periodontitis: ASystematic Review on Randomized Controlled Trails. Diabetes Ther. 2021;12(5):1249-1278. doi: 10.1007/s13300- 021-01000-6.

25. Stöhr J, Barbaresko J, Neuenschwander M, Schlesinger S. Bidirectional association between periodontal disease and diabetes mellitus: a systematic review and meta-analysis of cohort studies. Sci Rep. 2021;11(1):13686. doi: 10.1038/s41598-021-93062-6.

Downloads

Published

2025-06-16

How to Cite

1.
Shahid A, Khalid SA, Muneer M, Khan N, Iqbal S, Noor-ul-Huda. Evaluation of Periodontal Health in Diabetic Patients: Influence of Glycemic Control and Diabetes Duration Using the Community Periodontal Index – A Longitudinal Study: Periodontal Health in Diabetes. J Lahore med dent coll [Internet]. 2025 Jun. 16 [cited 2025 Jun. 22];2(01). Available from: https://jlmdc.lmdc.edu.pk/index.php/lmdc/article/view/70

Issue

Section

Original Articles