Public Health Implications of Chronic Periodontal Infections in Adults

Diabetes and its Complications: Designing New Therapies for this Epidemic
George L. King, MD, Director of Research, Joslin Diabetes Center, and Professor, Harvard Medical School, Harvard University, Boston, Massachusetts

Diabetes is increasing all over the world. In the United States alone, the number of people with diabetes is expected to increase to 18 million by 2010. This increase affects people at all socioeconomic levels, genders, and those from ethnic backgrounds.

Medical care costs for diabetes patients also are increasing dramatically. Direct medical costs for diabetes care in 1997 in the United States were $44 billion; by 2002 they had increased to $91.8 billion. Treatment for diabetes complications accounts for approximately 30% of medical care costs ($24.8 billion). The increase in diabetes is directly related to the rising percentage of people who are obese and to the aging of the population. Most of the increase in diabetes prevalence is for type 2 diabetes, which usually is diagnosed in adults, related to obesity, and not insulin-dependant. Evidence of type 1 diabetes is also rising, but the cause is unknown at this time although it is an autoimmune induced disease. Since type 1 diabetes accounts for only 10% of people with diabetes, its increase does not substantially affect the prevalence of diabetes in the general population.

Molecular understanding of both types 1 and 2 diabetes and their complications have improved dramatically over the past 20 years, leading to a host of new therapeutics that are just beginning to reach the clinical arena. New treatments for type 1 and 2 diabetes include islet cell transplant, agents to induce tolerance and prevent type 1 diabetes, custom designed insulin to mimic physiological response, and hypoglycemic agents to improve insulin secretion and sensitivity. New treatments for diabetic complications are also being designed based on the molecular understanding on the pathogenesis of diabetic vascular and neurological complications has led to new treatments for these complications. Hyperglycemia appears to be the main causal factor for diabetic microvascular and neurological diseases such as neuropathy, retinopathy, and nephropathy.

Both hyperglycemia and insulin resistance are related to cardiovascular complications of diabetes. The increased prevalence of periodontal disease in patients with diabetes is likey due to adverse effects of hyperglycemia and possibly insulin resistance. Several theories have been proposed, for example, increases in oxidative stress, glycation of proteins, and activation of cellular signaling such as protein kinase C (PKC) that might mediate most of hyperglycemia’s adverse effects. Both vascular and neurological changes have been shown to occur in correlation with changes in oxidant production, glycated protein, and PKC activation.

It is likely that these changes also occur in periodontal tissues. Further studies are needed to confirm the relationship between these molecular pathways and the occurrence of periodontal disease in diabetes patients. New treatments for periodontal disease in diabetes patients can improve dental health and may also improve diabetes care and other systemic problems in these patients.

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Historical Document
Page last reviewed: February 2, 2005
Content source: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion