Periodontal Disease Is Associated With Risk Of Incident Diabetes Among Non-Obese Individuals

Background: Strong evidence suggests that diabetes is a risk factor for periodontal disease and that periodontal disease, once established in the diabetic state, then contributes to worsened glycemic control. Recent studies suggest that periodontal disease is also associated with diabetes development. Hypothesis: Incident Type 2 Diabetes (T2D) rates will be higher among participants with baseline periodontal disease vs. those with periodontal health. The relationship is modified by Body Mass Index (BMI). Methods: We included 5586 diabetes-free eligible participants (aged 52-75 years) from Visit 4 (1996-1999) of The Atherosclerosis Risk in Communities (ARIC) Study. Participants received full-mouth periodontal exams and periodontal disease status was classified using Periodontal Profile Classes (PPC-Stages). T2D was defined based on participant-self report of physician diagnosis during annual telephone follow-ups. Time-to-event was computed from baseline through 2018. Competing risk, multivariable Cox proportional hazard models examined T2D and All-Cause Mortality risk according to baseline periodontal disease status. We tested the interaction with BMI. Multivariable adjustment was performed for race/center, age, gender, smoking and education. Results: Participants were mean age (SD) 62.4 (5.6), 55.0% female, 16.7% African American. During the average 21.1 years of follow-up there were 1,359 incident T2D cases and 1,531 deaths. Cumulative incidence rates were 24.3% and 27.4% for T2D and deaths, respectively. Among underweight participants, the hazard ratios[95%Cis] for incident diabetes among severe periodontitis or severe tooth loss (vs. periodontally healthy) were 1.84[1.14-2.96] and 2.29[1.57-3.33], respectively. Hazard ratios[95%Cis] among normal weight participants were 1.54[1.06-2.23] and 1.88[1.41-2.51], respectively. There were no significant associations with T2D in obese participants (p for interaction = 0.06. Conclusion: Severe periodontal disease was associated with a modestly increased risk for T2D among a multi-racial community-based sample. Two periodontal disease stages in the PPC-Stages index system are significantly associated with increased risk for incident diabetes. This periodontal disease-associated risk is modified by BMI levels and only associated with incident diabetes in study participants with lower BMI.