OBJECTIVE
Two-way relationship between periodontitis and diabetes was advocated. However, bidirectional epidemiological observation is still limited and inconsistent. Using the National Health Insurance Research Database of Taiwan (covering over 99% of the entire population), we estimate the development of diabetes in periodontitis patients or that of periodontitis in patients with type 2 diabetes mellitus (T2DM), respectively.
METHODS
A total of 11,011 patients with severe periodontitis were recruited from 2000 to 2015. After matching by age, sex, and index date, 11,011 patients with mild periodontitis and 11,011 non-periodontitis controls were registered. Conversely, 157,798 patients with T2DM and 157,798 non-T2DM controls were enrolled, whereas the development of periodontitis was traced. Cox proportional hazards model was performed.
RESULTS
Periodontitis patients tended to have a statistically high risk of having T2DM. Adjusted hazard ratio (aHR) was 1.94 (95% CI 1.49-2.63, p < 0.01) and 1.72 (95% CI 1.24-2.52, p < 0.01) for severe and mild periodontitis groups, respectively. Besides, the patients in severe periodontitis had a high risk of having T2DM compared to that in mild periodontitis [1.17 (95% CI 1.04-1.26, p < 0.001)]. Conversely, the risk of periodontitis increased significantly in patients with T2DM [1.99 (95% CI,1.42-2.48, p < 0.01)]. However, the high risk was observed for the outcome of severe periodontitis [2.08 (95% CI, 1.50-2.66, p < 0.001)], not for that of mild periodontitis [0.97 (95% CI,0.38-1.57, p = 0.462)].
CONCLUSIONS
We suggested the bi-direction is between T2DM and severe periodontitis, but not in mild type.