Bi-directional association between type 2 diabetes and periodontitis in the nationally representative sample comprising Taiwanese adults from 2000 to 2015

Abstract

Abstract Objective The two-way relationship between periodontitis and diabetes was advocated far past. However, the population-based bidirectional observation is still limited. Using the National Health Insurance Research Database of Taiwan, we estimate associations between pre-existing clinical periodontitis and incident type 2 diabetes mellitus (T2DM), and between pre-existing diabetes and incident periodontitis, respectively. Methods A total of 11,011 periodontitis patients who underwent periodontal therapy (Pt group) were recruited from 2000 to 2015. After matching by age, sex, and index date, 11,011 periodontitis patients who did not receive treatment (Pwt group) and 11,011 non-periodontitis controls were registered. The outcome of T2DM was traced. Conversely, 157,798 patients with T2DM and 157,798 non-diabetic controls were enrolled, whereas the development of periodontitis was traced. Cox proportional hazards model was performed. Results The patients with periodontitis tended to have a statistically high risk of having diabetes. The 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 Pt and Pwt, respectively. Using Pwt group as a reference, patients in Pt group had a high risk of having diabetes [aHR, 1.17 (95% CI 1.04–1.26, p < 0.001)]. Conversely, patients with T2DM tended to have a high risk of periodontitis [aHR, 1.99 (95% CI 1.44–2.48, p < 0.01)]. However, a high risk was noticed for the outcome subgroup of Pt only [aHR, 2.08 (95% CI, 1.50–2.66), p < 0.001)]. Conclusions The relationship between periodontitis and diabetes is bi-directional.