Recent data from the continuous National Health and Nutrition Examination Survey has shown that periodontal infections were linked with elevated insulin resistance in a sample of men and women without diabetes.
Previous studies have reported the presence of periodontal disease and its potential to increase the risk for incident type 2 diabetes and a five-fold increase in HbA1c levels, the researchers wrote.
“The potential for periodontal infections to contribute to insulin resistance and overt type 2 diabetes is biologically plausible, and one specific causal pathway linking infections and type 2 diabetes risk is chronically elevated systemic inflammation,” they wrote.
Ryan T. Demmer, PhD, from the department of epidemiology at Mailman School of Public Health at Columbia University in New York, and colleagues hypothesized that clinical periodontal disease was related to insulin resistance among patients without diabetes, and that data would support the role of inflammation as a mediator and effect modifier of the association, they said.
They used the National Health and Nutrition Examination Survey (NHANES, 1999-2004), where 3,616 patients (51% women) had undergone a periodontal exam and fasting blood glucose test. The patients enrolled had a mean age of 43 years. In separate analyses, white blood cell (WBC) count and C-reactive protein were considered as mediators or effect modifiers.
Through linear regression, Demmer and colleagues found geometric HOMA-IR levels increased by 1.04 for every 1-mm periodontal probing-depth (PD) increase (P=.007); WBC mediated 6% of the link (P<.05), according to data. For patients with WBC ≤6.4 ×109, PD was not associated with HOMA-IR ≥ 3.30, they wrote.
“The fact that PD, and not attachment loss (AL), was associated with HOMA-IR is notable because it suggests that clinical indicators of current infection and/or inflammation are more relevant when studying cross-sectional associations between periodontal infection and insulin resistance,” they wrote.
Demmer and colleagues suggest further research should be conducted to determine the causal relationship.
Disclosure: The researchers report no relevant financial disclosures.