Inflammatory mechanisms associated with type 1 diabetes mellitus and oral diseases

Abstract

Diabetes is a well-known risk factor for periodontal disease; however, the pathogenic links between periodontal disease and type 1diabetes (T1DM) are not completely understood. Therefore, this study evaluated, longitudinally over 6 months, the impact of periodontal disease and its treatment on clinical outcomes, glycated haemoglobin (HbA1c), high-sensitivity C-reactive protein (hsCRP), lipids and local and systemic levels of pro-inflammatory biomarkers [matrix metalloproteinase-9 (MMP-9), B-cell activating factor, resistin, epithelial neutrophil activating peptide-78/CXCL5 (ENA-78/CXCL5) and interleukin-8, (IL-8)] in patients with T1DM. 57 T1DM and 43 non-T1DM patients were recruited. Pre-treatment, T1DM patients had significantly lower diastolic BP, non-HDL and cholesterol compared to non-T1DM patients. T1DM periodontally healthy patients had significantly higher bleeding on probing (BOP) scores compared to non-T1DM periodontally healthy patients. Serum MMP-9, resistin and ENA-78/CXCL5 levels were significantly higher in T1DM patients compared to non-T1DM patients. Furthermore, T1DM periodontitis patients had significantly higher serum MMP-9 levels compared to non-T1DM periodontitis patients. Regardless of diabetes status, GCF MMP-9 levels were significant predictors of clinical periodontal condition. Moreover, T1DM periodontally healthy patients had significantly higher GCF MMP-9 and IL-8 levels compared to non-T1DM periodontally healthy patients. In T1DM and non-T1DM patients, all clinical periodontal parameters significantly improved at 3 and 6 months following non-surgical periodontal management (NSM), and both groups demonstrated significant reductions in GCF MMP-9 levels at month 6 following NSM. Furthermore, following NSM, GCF IL-8 levels significantly reduced at 3 and 6 months in T1DM patients and at month 3 in non-T1DM patients. In T1DM patients, HbA1c showed 0.45% and 0.90% reductions at 3 and 6 months following NSM, respectively, although these reductions were not statistically significant. In conclusion, NSM led to significant reductions in GCF MMP-9 and IL-8 levels, and these inflammatory mediators may play a role in the pathogenesis of periodontitis in patients with T1DM.