[Periodontal health status and associated factors in community-managed patients with type 2 diabetes mellitus in Nanjing].

Objective

To investigate the prevalence, severity, and influencing factors of chronic periodontitis in patients with type 2 diabetes mellitus (T2DM) in Nanjing.

Methods

From June to August 2022, by using a multi-stage stratified cluster random sampling method, a total of 1 477 community-dwelling T2DM patients aged 35 years and older were selected and included from the National Essential Public Health Services Program for T2DM health management. Physical examinations, laboratory tests, and questionnaire surveys were conducted. Study participants were divided into chronic periodontitis group and non-chronic periodontitis group. The chronic periodontitis group was defined as having interproximal clinical attachment loss (CAL) detected at least at two non-adjacent sites, or having buccal/lingual CAL≥3 mm at least at two sites with probing depth (PD)≥3 mm, while excluding CAL caused by non-periodontal reasons. The remaining participants were classified as the non-chronic periodontitis group. In the chronic periodontitis group, patients who had PD≥6 mm at least at two sites with CAL≥5 mm were defined as severe periodontitis, with remaining cases classified as mild-to-moderate periodontitis.

Results

The prevalence of chronic periodontitis among T2DM patients was 70.1% (962/1 373), with mild to moderate and severe periodontitis prevalence rates of 62.4% (857/1 373) and 7.6% (105/1 373), respectively. After complex weighted processing, the prevalence of chronic periodontitis in T2DM patients was 67.9%, with mild to moderate and severe periodontitis prevalence rates of 61.2% and 6.7%, respectively. Multivariate logistic regression analysis showed that after adjusting all covariates, compared with mental workers, the risk of chronic periodontitis was significantly higher in retired people (OR=1.78, 95%CI: 1.75-1.81, P<0.001), unemployed/others (OR=2.18, 95%CI: 2.14-2.22, P<0.001), and physical workers (OR=3.80, 95%CI: 3.73-3.87, P<0.001). In terms of blood glucose control status, compared with the group that met both control targets, the risk of chronic periodontitis was significantly higher in the group that met only one target (OR=1.28, 95%CI: 1.27-1.30, P<0.001) and the group that met neither target (OR=3.29, 95%CI: 3.25-3.34) (P<0.001). The results of ordered Logistic regression showed that after adjusting for all covariates, compared with male patients, female patients had a significantly lower risk of progression to severe periodontitis (OR=0.77, 95%CI: 0.76-0.78, P<0.001). In terms of the score of healthy lifestyle, compared with those with a score of 0-2, the risk of progression to severe periodontitis was significantly lower in those with a score of 3 (OR=0.85, 95%CI: 0.84-0.86, P<0.001) and 4 (OR=0.51, 95%CI: 0.50-0.52, P<0.001). In terms of blood glucose control, compared with the group that met both control targets, the risk of progression to severe periodontitis was significantly higher in the group that met only one target (OR=1.27, 95%CI: 1.26-1.29, P<0.001) and the group that meet neither target (OR=3.24, 95%CI: 3.21-3.28, P<0.001). Furthermore, poor blood glucose control was significantly positively associated with increased periodontitis severity, demonstrating that worse glycemic control status corresponded to a higher risk of worsening periodontitis severity (P<0.001).

Conclusions

There is an association between the glycemic control status of T2DM patients and chronic periodontitis.