Association of periodontitis stages with glycemic control in adults with and without type 2 diabetes mellitus: a cross-sectional study.

OBJECTIVE

To investigate associations among periodontal parameters, glycated hemoglobin (HbA1c), and metabolic parameters in adults with and without type 2 diabetes mellitus (T2D).

METHODOLOGY: A cross-sectional study included 74 adults diagnosed with periodontitis according to the current periodontal classification of 2018. Participants underwent a full-mouth periodontal examination, laboratory assessment, and Body Mass Index (BMI). Periodontitis was categorized into Stages I/II and Stages III/IV. HbA1c, lipid profile, high-sensitivity C-reactive protein (CRP), and insulin resistance (HOMA-IR) were assessed. Periodontal inflammatory burden was quantified using the Periodontal Inflamed Surface Area (PISA). Non-parametric tests and Spearman correlation analyses were performed, stratified by diabetes status (α=5%).

RESULTS

Individuals with advanced periodontitis (Stages III/IV) had significantly higher HbA1c levels (6.8% vs. 5.8%; p=0.007), higher triglyceride concentrations (142.0 vs. 100.5 mg/dL; p=0.016), and lower HDL-cholesterol levels (46.0 vs. 52.0 mg/dL; p=0.012) than those in Stages I/II. Poor glycemic control (HbA1c >8.5%) and T2D duration ≥10 years were significantly associated with advanced stages (p<0.05). No significant differences were observed for BMI, LDL, total cholesterol (TC), CRP, or HOMA-IR between groups. In adults with T2D, PISA correlated positively with TC and LDL-cholesterol, whereas in non-diabetic individuals, PISA was associated primarily with triglycerides.

CONCLUSIONS

Advanced periodontitis was associated with poorer glycemic control and a more atherogenic lipid profile, particularly characterized by elevated triglycerides and reduced HDL-cholesterol. The findings support periodontitis as a potential marker of systemic metabolic dysregulation and reinforce the importance of integrating periodontal care into cardiometabolic risk management strategies.