Association of Apical Periodontitis with Glycated Hemoglobin Levels and Systemic Inflammatory Markers in Patients with Type 2 Diabetes: A Cross-Sectional Study

Introduction: This cross-sectional study, as a preliminary part of an ongoing project, aimed to investigate the effect of apical peridontitis (AP) on glycated hemoglobin (HbA1c) and systemic inflammatory markers in diabetic individuals.

Methods: A total of 280 individuals (140 with type 2 diabetes mellitus [T2DM] and 140 healthy) with and without AP were enrolled. Sixty-four age-, gender-, and body mass index-matched participants each in T2DM with AP group (DAP), T2DM without apical periodontitis (D), systemically healthy controls with apical periodontitis (CAP), and without apical periodontitis (C) groups were evaluated. Radiologic and clinical oral examination was performed for confirming the diagnosis of AP and periapical index scoring (PAI). Blood analyses were carried out for interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, high-sensitivity C-reactive protein (hsCRP), and HbA1c assessment.

Results: Significantly higher levels of IL-1β, TNF-α, and hsCRP were observed in patients with AP in both diabetes and control groups (P < .05). In the diabetes group, AP contributed to significantly raised levels of HbA1c compared with T2DM group patients without AP. After controlling for possible confounders, partial corelation coefficients revealed positive corelation of presence of AP as well as size of the periapical lesion with HbA1c and serum levels of inflammatory markers in both diabetic and healthy individuals. Multivariate linear regression analysis revealed both presence of AP (P < .05) as well as the size of lesion (P < .001) were found to significantly predict the HbA1c levels as well as the levels of IL-1β, IL-6, TNF-α, and hsCRP in both diabetic and non-diabetic individuals.

Conclusions: These findings suggest that both presence of AP and size of periapical lesion was associated with glycemic control and systemic inflammatory burden in patients with T2DM.