Periodontitis Associated With Development of Type 2 Diabetes and Its Complications

SAN FRANCISCO, CA, Jun 06 (MARKET WIRE) --
Critical links between periodontal (gum) disease and the development of type 2
diabetes, as well as the development and progression of its complications,
were reported here today in the first ever symposium presented by dentists to
diabetes experts at the American Diabetes Association's Annual Scientific
Sessions at its 68th such event.

"One of the many complications of diabetes is a greater risk for periodontal
disease," said Maria E. Ryan, DDS, PhD, Professor of Oral Biology and
Pathology, and Director of Clinical Research, School of Dental Medicine, Stony
Brook University, New York, in a recent interview. "If you have this oral
infection and inflammation, as with any infection, it's much more difficult to
control blood glucose levels." Intensive periodontitis treatment significantly
reduces
levels of A1C, a measure of glucose control over the prior two to three months.

These links between oral and systemic health may start even before
clinicaldiabetes begins. "We have found evidence that the severity of
periodontal disease is
associated with higher levels of insulin resistance, often a precursor of
type 2 diabetes, as well as with higher levels of A1C, a measure of poor
glycemic control of diabetes," she said.

The importance of these findings were emphasized by her colleague, George W.
Taylor, DrPH, DMD, Associate Professor of Dentistry, Schools of Dentistry
and Public Health, University of Michigan. "Several recent studies have shown
that having periodontal disease makes those with type 2 diabetes more
likely to develop worsened glycemic control and puts them at much greater
risk of end-stage kidney disease and death," he reported.

"Given the numerous medical studies showing that good glycemic control
results in
reduced development and progression of diabetes complications, we believe there
is the
potential that periodontal treatment can provide an increment in diabetes
control and subsequently a reduction in the risk for diabetes complications,"
said Dr. Taylor.

Nearly 21 million Americans have diabetes, a group of serious diseases
characterized by high blood glucose levels that result from defects in the
body's ability to produce and/or use insulin. Diabetes can lead to severely
debilitating or fatal complications, such as heart disease, blindness, kidney
disease, and amputation. It is the fifth leading cause of death by disease in
the U.S. Type 2 occurs mainly in adults who are overweight and ages 40 and
older.

Periodontal (gum) disease is an infection and chronic inflammatory disease
of the
tissues surrounding and supporting the teeth. It is a major cause of tooth
loss in adults. In periodontitis, unremoved plaque hardens into calculus
(tartar), gums gradually begin to pull away from the teeth, and pockets form
between the teeth and gums. However, people often do not know they have
periodontal disease because it is usually painless.

Periodontitis Associated with Insulin Resistance and Diabetes Severity

"In an analysis of the National Health and Nutrition Examination Survey of
the U.S. population data from 1988-94, we recently found that people with
periodontal disease were twice as likely to have insulin resistance than those
without such disease," said Dr. Taylor. This result was found after
controlling for other characteristics that would be associated with
insulinresistance, such as obesity, lipids, exercise, and other markers of
inflammation, such as CRP, and whether or not they had diabetes.

In an unpublished study at the General Clinical Research Center at Stony
Brook
University, a group of individuals who were by one measure -- RD values (a
measure of glucose uptake and insulin sensitivity) -- insulin resistant, and
likely had pre-diabetes, also had their oral health assessed. Their degree of
insulin resistance directly correlated with the severity of their periodontal
disease.

"The inflammation from the oral cavity may be contributing to the insulin
resistance in this patient population," said Dr. Ryan.

Also measured in this group were levels of cytokines, such as IL-1 beta,
which
are pro-inflammatory mediators involved in the long-term diabetes complications.

"Genetic testing revealed that 50% of the insulin resistant patients had an IL-1
polymorphism -- in contrast to 20% in the overall population, meaning that they
are genetically susceptible to an excessive inflammatory response, and this 50%
was
the group that had high levels of insulin resistance and more severe
periodontal disease," she said.

The presence of the IL-1 polymorphism fits with one theory of how
periodontitis worsens glycemic control in type 2 diabetes.

"We think periodontitis may adversely affect glycemic control because the
pro-inflammatory chemicals produced by the infection -- such as IL-1-beta, IL-6,
and
TNF-alpha -- could transfer from the gum tissue into the bloodstream and
stimulate cells to become resistant to insulin," said Dr. Taylor. "Then
insulin resistance prevents cells in the body from removing glucose from the
bloodstream for energy production."

Periodontitis Associated with Diabetes Complications

Dr. Taylor reported on studies at the University of Michigan and elsewhere
demonstrating the association between periodontitis and the complications of
type 2
diabetes.

"A recent set of observational studies of the Pima Indians in the
Southwest,
a population with a very high rate of type 2 diabetes, investigated whether
those
with periodontitis are more likely to develop poorer glycemic control," said Dr.
Taylor. "We found that those with periodontitis were more than four times as
likely to develop worsened glycemic control after two years of follow-up."

Studies of Pima Indians published by others have shown a higher risk of
diabetes complications in those with periodontal disease. For example,
oneshowed that residents of the Gila River Indian Community with severe
periodontal
disease were at more than three times the risk of death due to diabetic
nephropathy or ischemic heart disease than those with no, mild, or moderate
periodontal disease over 11 years.

Periodontal Treatment Can Improve Diabetes Control

"Just as periodontal disease makes diabetes worse, the reverse also
appearsto be true, with improvements in periodontal disease benefiting diabetes
control,"
said Dr. Taylor. "We conducted an NIH-funded, randomized clinical trial in 46
people with type 2 diabetes and, 15 months after routine periodontal treatment,
found a statistically significant reduction of 0.67% in A1C levels," said Dr.
Taylor.

"We recently published a randomized, placebo-controlled, 30-patient study
done
at the General Clinical Research Center at Stony Brook University showing that a
sub-antimicrobial dose of doxycycline, during and after root planing, as part
of a 9-month course of treatment, significantly reduced A1C by 1% and also
reduced proteinuria, a marker of diabetic kidney disease, and CRP, a marker of
inflammation," said Dr. Ryan. "It also significantly reduced pocket depths
associated with periodontitis and enabled gains in clinical attachment, while
reducing signs of inflammation, such as bleeding upon probing or brushing." Two
confirmatory 3-month studies of this program developed at Stony Brook have been
conducted, at Columbia University and Buffalo University with 150 patients,
and presented at International Association for Dental Research meetings.

"When glycemia has been difficult to control, the physician might consider
asking
patients when they last saw their dentist, whether periodontitis has been
diagnosed and, if so, whether treatment has been completed," said Dr. Ryan.
"A consultation with the dentist may be appropriate, to discuss whether
periodontal treatment has been successful or whether a more intensive approach
with oral or sub-antimicrobial antibiotics is in order because, just as it is
difficult to control diabetes while the patient has an infected leg ulcer,
the same applies when there's infection and inflammation of the gums."

The American Diabetes Association is the nation's leading voluntary health
organization supporting diabetes research, information and advocacy. Founded in
1940, the Association has offices in every region of the country, providing
services to hundreds of communities. For more information, please call the
American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit
www.diabetes.org.Information from both these sources is available in English and
Spanish.

Symposium, Friday, 4:15 pm

NOTE TO EDITOR:

Visit http://www.diabetes.org/adablog to read blog posts from the
Association's Scientific Sessions from former USA Today reporter, Anita Manning.

Contact:
Diane Tuncer
(703) 299-5510
Colleen Fogarty
(703) 549-1500 ext. 2146
NEWS ROOM:
June 6-10, 2008:
Room 250, Moscone Convention Center
(415) 978-3508
Fax: (415) 978-3524

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