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Periodontal Disease and Incident Type 2 Diabetes Mellitus: Results from the First National Health and Nutrition Examination Survey and its Epidemiologic Follow-up Study

¹Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
²Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; also affiliated with the Department of Nutrition, University of Oslo
³INSERM, Paris and UMR-S 707, Universite Pierre et Marie Curie-Paris6, Paris, France

rtd2106{at}columbia.edu

ABSTRACT

Objective: Type 2 Diabetes Mellitus (diabetes) and periodontal disease are known to be associated but the temporality of this relationship has not been firmly established. We investigated whether baseline periodontal disease independently predicts incident diabetes over two decades of follow-up.

Research Design and Methods: 9,296 nondiabetic male and female National Health and Nutrition Examination Survey (NHANES I) participants aged 25-74 years who completed a baseline dental examination (1971–1976) and at least one follow-up evaluation (1982–1992) were studied. We defined 6 categories of baseline periodontal disease using the periodontal index (PI). Of 7,168 dentate participants, 47% had PI=0 ("periodontally health"); the remaining were classified into PI quintiles. Incident diabetes was defined by: i) death certificate (ICD-9 code 250); ii) self-report diabetes requiring pharmacological treatment; or iii) healthcare facility stay with diabetes discharge code. Multivariable logistic regression models assessed incident diabetes odds across increasing levels of PI in comparison to periodontally healthy participants.

Results: The adjusted odds ratios (OR) for incident diabetes in periodontal index categories 1 and 2 were not elevated while the OR in periodontal index categories 3 through 5 were: 2.26 (95%CI:1.56,3.27), 1.71 (95%CI:1.09,2.69) and 1.50 (95%CI:0.99,2.27), respectively. OR in edentulous was 1.30(95%CI:1.00, 1.70). Dentate participants with advanced tooth loss realized an OR=1.70(p<0.05) relative to those with minimal tooth loss.

Conclusions: Baseline periodontal disease is an independent predictor of incident diabetes in the nationally representative sample of NHANES I.

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