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Periodontal
disease associated with higher
levels of insulin resistance,
studies say.
SATURDAY,
June 7 (HealthDay News) -- People
with type 2 diabetes can help
control the disease by taking
better care of their teeth and
gums.
That's
the case dentists were expected
to make at the American Diabetes
Association's annual meeting
in San Francisco this weekend.
"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," George
W. Taylor, an associate professor
of dentistry at the University
of Michigan schools of Dentistry
and Public Health, said in a
prepared statement. "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,"
he said.
Intensive
periodontitis intervention,
for example, can significantly
lower one's levels of A1C, a
measure of long-term glucose
control.
"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," dentist Maria
E. Ryan, director of clinical
research at the Stony Brook
University School of Dental
Medicine in New York, said in
a prepared statement.
Periodontal,
or gum, disease is an infection
and chronic inflammatory disease
of the tissues surrounding and
supporting the teeth. As it
is painless, most people don't
know they have it, yet it is
a major cause of tooth loss
in adults.
Among
the studies to be discussed
linking gum disease and diabetes
are:
*
A 1988-1994 U.S. population
data study that found having
periodontal disease put a person
at twice the risk of having
insulin resistance as those
without such disease.
*
An unpublished Stony Brook University
study of people displaying pre-diabetic
insulin resistance that links
the severity of a periodontal
disease with their degree of
insulin resistance. "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,"
Taylor said. "Then insulin
resistance prevents cells in
the body from removing glucose
from the bloodstream for energy
production."
*
A set of studies of the Pima
Indians in the Southwest, a
population with a very high
rate of type 2 diabetes. One
found those with periodontitis
were more than four times as
likely to develop worsened glycemic
control; another showed that
those with severe gum disease
had more than triple the risk
of dying from diabetic nephropathy
or ischemic heart disease than
those with less severe periodontal
disease.
*
A study, funded by the National
Institutes of Health, that found
a "statistically significant
reduction" in A1C levels
in people with type 2 diabetes
after 15 months after routine
periodontal treatment, Taylor
said.
"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,"
Ryan said. "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."
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