The Diabetes Connection - Combating a Growing Epidemic
of Our Modern Lifestyle
By William Gussow, DDS
The diet of the average American is cause for great concern in
the medical and dental communities. We are eating excessive amounts
of fats, starches, and sugars (diets high in trans-fats and simple
and complex sugars). Diabetes is developing at an unprecedented
rate in our country and millions of people are not aware of their
condition. Living with undiagnosed and untreated diabetes can have
a very rapid detrimental effect on a person's health.
The Prevelance of Diabetes
According to the American Diabetes Association about 20% of
Americans are affected by Diabetes:
• 13 million people or 4.3% of the population have diagnosed
diabetes.
• 5.2 million people, another 2% of the population have undiagnosed
diabetes
• 41 million people or 14% of the population are pre-diabetics
• The rate is 1.5 times higher in Latinos and 24% of Mexican
Americans have diabetes
• About 10% are type 1, insulin dependent diabetics while
the remaining 90% are type 2, who do not process sugar properly.
The Rate of Periodontal Disease in Diabetics
Periodontal disease in the normal population is rare before age
20 and increases steadily to 60% in the 45-54 age group. However,
thirty percent of 20-year-old diabetics have periodontal disease,
reaching 50% by age 35 and 80+% in the 45-54 group. In general,
the rate of periodontal disease among diabetics is double the "normal"
population. According to the American Academy of Periodontology,
the link between diabetics and periodontal disease means that diabetics
have double the rate of periodontal disease than the non-diabetic
population.
The Risk of Periodontal Disease in Diabetics
We have discussed the anaerobic bacteria that live in the deep crevices
and periodontal pockets. When these bacteria get into the blood
system they make it more difficult for a diabetic to control their
blood sugar. Additionally, the loss of teeth is a real problem for
diabetics since their support for a denture erodes away more rapidly
than in the non-diabetic person. Diet and nutrition are usually
compromised with an undesirable increased intake of refined carbohydrates.
Periodontal disease increases the rate of C-Reactive Protein, which
also causes problems for diabetics and combines with elevations
in blood sugar (also noted in higher HbA1c levels) to greatly increase
the rate of heart attacks (26).
The result is that periodontal disease greatly increases the mortality
rate in diabetics, possibly up to a factor of 7.5! (5). The National
Institute of Diabetes and Digestive and Kidney Disease, monitored
628 type II diabetics for an average of 11 years. 204 subjects died
during the study. The age adjusted death rates were 3.7% for mild
or no periodontal disease, 19.6% for moderate periodontal disease
and 28.4% for severe periodontal disease. The primary causes of
death associated with periodontal disease were ischemic heart disease
(heart attacks) and diabetic nephropathy (kidney disease).
Diabetes Prevention
As we have seen, the periodontal bacteria living in the gum pockets
increase blood sugar, which would lead one to suspect that people
with periodontal disease would be more likely to develop diabetes.
A study from Japan called the Hisayama study (3) reviewed the records
on 961 persons for ten years. Subjects with normal glucose tolerance,
but deeper periodontal pockets at the beginning of the study developed
more diabetes 10 years later. Therefore, it was concluded that treatment
of periodontal disease may reduce the development of diabetes.
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Glycated Hemoglobin - HbA1c
When you have uncontrolled diabetes you have too much sugar in your
bloodstream. This extra glucose enters your red blood cells and
links up (or glycates) with molecules of hemoglobin. The more excess
glucose in your blood, the more hemoglobin gets glycated. It is
possible to measure the percentage of A1C in the blood. The result
is an overview of your average blood glucose control for the past
few months. Research indicates that that certain periodontal bacteria
increase HbA1c. The good news is that successfully treating diabetic
gum disease, including use of anti-microbial treatment, can significantly
reduce HbA1C (4).
Because of the strong connection between periodontal disease and
diabetes, we test all periodontal patients for HbA1c. If your level
is found to be high, we will collaborate with your physician to,
hopefully, reduce the risk of diabetes. If you already have diabetes,
we will try to help you control it to minimize your risk of associated
diseases such as cardiovascular and kidney disease.
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