Periodontal Disease is Associated with Prediabetes and Elevated Glucose Among Non-Diabetic Adults: Results from the Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS)

Hamdi Adam

PhD, Epidemiology

Hamdi S. Adam, Rebecca Molinsky, Sumith Roy, Michael Rosenbaum, Bruce Paster, Melana Yuzefpolskaya, Paolo C. Colombo, Panos N. Papapanou, Moïse Desvarieux, David R. Jacobs Jr., Ryan T. Demmer

Ryan Demmer

Periodontal disease, Prediabetes


Background: Periodontal disease is a bacterially-driven, inflammatory disease of the gums. It is a plausible risk factor for diabetes mellitus. However, less is known about whether periodontal health is related to preclinical diabetes (prediabetes). 

Hypothesis: We hypothesize that periodontal disease is cross-sectionally associated with elevated prediabetes prevalence and biomarkers of cardiometabolic risk among non-diabetic younger adults.

Methods: We enrolled n=1071 (2011-2013: n=293; 2016-2020; n=778) non-diabetic participants from the Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS). Measures of historical periodontal disease (periodontal disease status and attachment loss [AL]) and active periodontal disease (probing depth, bleeding on probing) were ascertained from full-mouth examinations. Glucose, HbA1c, and insulin resistance (via HOMA-IR) were assessed from fasting blood samples. Prediabetes was defined as fasting glucose between 100-125 mg/dL or HbA1c between 5.7-6.4% per American Diabetes Association guidelines. We used multivariable Poisson with robust variance estimation to compute prevalence ratios of prediabetes and multivariable linear regression to estimate cardiometabolic biomarker levels across categories of periodontal health measures. Models were adjusted for demographics, health variables, and study wave. 

Results: The mean age(SE) of participants was 32.3(0.3) years and 73% were female. Prediabetes prevalence was 12.5% overall, and was more frequent as AL increased. Adjusted prevalence ratios (95%CIs) for prediabetes in Tertiles 2 and 3 of AL (vs. 1) were 1.34(0.79, 1.88) and 1.98(1.39, 2.56), respectively. AL was positively associated with continuous glucose and HbA1c. 

Conclusion: Attachment loss, a historical measure of periodontal disease, was associated with increased prediabetes prevalence and poorer cardiometabolic profile.


This study was supported by NHLBI T32 Cardiovascular Epidemiology and Prevention Pre-doctoral Fellowship

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