Prediabetes, Periodontitis and Atherosclerotic Cardiovascular Disease: Associations in a Nested Case-Control study

Author(s): Eisfeld M, Schulte B, Schlicht K, Mewes L, Lieb W, Spille JH, Naujokat H, Schreiber S, Dörfer C, Wiltfang J, Laudes M, Schulte DM, Graetz C, Wagner J

Periodontitis and type-2-diabetes are mutually dependent on each other with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Underdiagnosed Prediabetes is also associated with ASCVDs, but without approved therapy. Thus, this study aimed to investigate whether there is an association between periodontitis and prediabetes.

For a systems medicine approach n=746 subjects from the Kiel Food Chain Plus (FoCus)-cohort were included. Mild (n=245) and severe (n=128) periodontitis were compared with case-matched controls (n=373) in occurrence of prediabetes. P-values below 0.05 after adjustment due to multiple testing (Benjamini and Hochberg) were considered statistically significant.

Subjects with severe periodontitis and an assumed prediabetes with a homeostasis model assessment Insulin resistance value between 2 and 5 had significantly higher fasting glucose (102.5[96.25-108.75]mg/dl vs 98[91.5-103] mg/dl;median[IQR];p=0.047). With an extended prediabetes range (glucose 90-125mg/dl) subjects without diabetes and severe periodontitis had significantly higher fasting glucose levels than controls (103[98-109]mg/dl vs 99[93.75-105]mg/dl;p=0.02). Correlations analyses showed that severe periodontitis and fasting glucose in subjects without diabetes with a fasting glucose of 90-125 mg/dl are significantly correlated (r=0.21;p=0.02). ASCVDs were significantly more frequent in cases with periodontitis (overall) and severe periodontitis (OR1.6 and 2.1;p=0.02).

For the first time, a connection between the inflammatory metabolic disease periodontitis and prediabetes could be shown. Our data suggest, that the cutoff for systemic effects on impaired glucose tolerance might be set to lower levels than nowadays, especially for periodontitis. Further studies are indicated to investigate mutual disease triggers and therapy effects. The therapy of periodontitis could represent the first rational therapy of prediabetes.