An Evaluation of the relationship between Periodontal Disease Status and Glycemic Control in patients with Type 2 Diabetes Mellitus

BACKGROUND: Periodontal disease status in diabetic patients has been shown to correlate positively with Plasma HbA1c. But its association with serum Fructosamine remains unclear, more so, when the severity is expressed as a continuous quantitative variable. AIM OF THE STUDY: To analyze the relationship between HbA1c, Fructosamine (FA) and periodontal disease severity expressed as Attachment Loss Surface Area (ALSA) and Periodontal Inflamed Surface Area (PISA) in patients with and without Type 2 Diabetes Mellitus. MATERIALS AND METHODS: ALSA and PISA were calculated in 60 type 2 diabetics and 40 non-diabetics with generalized chronic periodontitis and their HbA1c and FA levels were assessed using an enzymatic assay. Pearson correlation was used to analyze the association between these variables. Multiple linear regression (backward) was performed to analyze the predictability of ALSA and PISA from these glycemic markers, age, gender, duration of diabetes and Plaque index (Pl I). RESULTS: The glycemic markers showed a very high inter-correlation in the diabetics and a moderate correlation in the non-diabetic group. They exhibited a good to moderate correlation with ALSA and PISA in the diabetics and none significant in the non-diabetics. Multiple regression analysis revealed that the most significant predictors for ALSA in the diabetic group were the glycemic control, Pl I and age, while those for PISA were glycemic control and Pl I. The only significant predictor of PISA in the non-diabetics was Pl I and none was significantly predictive of ALSA in this group. CONCLUSIONS: Fructosamine is a valid alternative to HbA1c for the evaluation of glycemic status in generalized chronic periodontitis patients with Type 2 Diabetes. Poor glycemic control has a significant and direct contribution towards ALSA and PISA in these patients