Danish Study Reveals Connection Between Diabetic Neuropathy, Retinopathy, and Severe Periodontitis

The study revealed that diabetic neuropathy and retinopathy, whether considered separately or together, were linked to moderate or severe periodontitis. Additionally, dyslipidemia further increases the risk of moderate or severe periodontitis among those with diabetic microvascular complications.

"These insights could help in identifying at-risk subgroups for both diabetes-related microvascular complications and periodontitis, ultimately improving strategies to reduce the overall disease burden," the researchers wrote.

Evidence on the relationship between diabetes-related microvascular complications and periodontitis remains inconsistent, with reliable estimates hampered by small sample sizes and residual confounding factors. Additionally, the impact of both microvascular complications and dyslipidemia on periodontitis has yet to be thoroughly investigated. Therefore, F.V. Bitencourt, Aarhus University, Aarhus, Denmark, and colleagues aimed to explore the relationship between individual and combined diabetic microvascular complications, such as neuropathy and retinopathy, and moderate to severe periodontitis in a Danish population-based study. They also evaluated whether dyslipidemia modified these associations.

This study included 15,922 participants with type 2 diabetes from the Health in Central Denmark study. Multinomial logistic regression was employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for both individual and combined microvascular complications of diabetes. The models accounted for potential confounders such as sociodemographic factors, lifestyle behaviors, and health conditions.

Inverse probability of treatment weighting (IPTW) was used to balance measured confounders between participants with and without periodontitis. Sensitivity analyses assessed the robustness of the findings by calculating E-values for unmeasured confounding and by varying the definitions of microvascular complications.

The following were the key findings of the study:

• After IPTW, adjusted models revealed that diabetic neuropathy (OR 1.36) and retinopathy (OR 1.21) were significantly associated with moderate/severe periodontitis.
• The coexistence of microvascular complications increased the odds 1.5-fold for moderate/severe periodontitis (OR 1.51).
• An effect modification of dyslipidemia on an additive scale was found, indicated by a positive relative excess risk due to an interaction of 0.24 for neuropathy, 0.11 for retinopathy, and 0.44 for both complications.
• Sensitivity analysis ruled out unmeasured confounders and microvascular complication definitions as explanatory factors.

A limitation of the study was that periodontitis and microvascular complications were self-reported. The researchers acknowledged that a clinical assessment could have offered a more precise evaluation of the extent of diabetic neuropathy and retinopathy in individuals with diabetes.

Reference:

Bitencourt, F. V., Andersen, A., Bjerg, L., Sandbæk, A., Li, H., Nascimento, G. G., Spin-Neto, R., Peres, M. A., & Leite, R. M. (2024). Periodontitis and Diabetes Complications: A Danish Population-Based Study. Journal of Dental Research. https://doi.org/10.1177/00220345241259954