Management of periodontitis in patients with type 2 diabetes : the clinical and biological response

PhD ThesisType 2 diabetes (T2DM) is a risk factor for periodontal disease, however the pathogenic links between the two disease are not completely understood. Both diseases are considered to be inflammatory conditions and, therefore, cytokines are likely to play a role in the shared susceptibility between the two diseases. Therefore, the study evaluated, longitudinally over 12 months, the impact of periodontal therapy on clinical outcomes, glycaemic control, hsCRP, lipids and local and systemic levels of IL-6, TNF- α, IL-1β and IFN-γ in patients with T2DM. 101 T2DM and 83 non-diabetic subjects were recruited and, of these, periodontitis was diagnosed in 47 T2DM and 48 non-diabetic subjects. Pre-treatment, subjects with T2DM had significantly higher BMI and significantly lower systolic BP and cholesterol compared to non-diabetic subjects. Serum levels of TNF-α, IL-1β and IFN-γ were significantly higher in subjects with T2DM compared to non-diabetic subjects. Regardless of diabetic status, GCF and salivary levels of IL-1β were significant predictors of the clinical periodontal condition. In T2DM and non-diabetic subjects, all clinical periodontal outcomes were significantly improved at 3, 6 and 12 months following NSM and both groups demonstrated significant reductions in GCF IL-1β levels at 3, 6 and 12 months. In nondiabetic subjects, a significant reduction in non-HDL and cholesterol was seen 6 months after NSM. In subjects with T2DM, serum TNF-α was significantly reduced 3 and 6 months after NSM. In subjects with T2DM, HbA1c showed 0.45% and 0.40% reductions at 3 and 12 months after NSM, although these reductions did not achieve statistical significance. Abstract XVII In conclusion, periodontal therapy led to significant reductions in GCF IL-1β in all subjects, and also produced a significant reduction in circulating levels of TNF-α in subjects with T2DM. Furthermore, IL-1β in saliva and GCF appear to be good prognostic markers for periodontitis regardless of diabetes status.Royal College of Surgeons Edinburgh Dunhill Medical Trus