What is the role of hyperlipidemia in the interrelationship between diabetes and periodontitis?

This summary is based on the article published in Archives of Oral Biology: Interrelationship between diabetes and periodontitis: Role of hyperlipidemia (April 2015)

Xiaodong Zhou, Wenyi Zhang, Xiaoli Liu, Wu Zhang, Yiming Li

Context

• Diabetes mellitus and periodontitis are both common, chronic diseases.
• It is generally accepted that the inter-relationship between diabetes mellitus and periodontitis is a two-way relationship, i.e. the presence of one condition tends to increases the risk and severity of the other, and vice versa.
• Mechanisms for this two-way relationship are largely unknown.
• Hyperlipidemia is a group of disorders characterized by an excess of lipids in the bloodstream and it increases the risk of diabetes and peridontitis.
• On the other hand, diabetes and periodontitis could result in hyperlipidemia.

Purpose of the Review

1. Examine the two-way relationship between diabetes mellitus and periodontitis.
2. Discuss the potential synergistic interactions of hyperlipidemia to both diabetes mellitus and periodontitis.
3. Explore the mechanisms through which hyperlipidemia affects the development of both diseases.

Key Findings

• The effects of hyperlipidemia on insulin secretion and pro-inflammatory cytokines production (TNF-a, IL-1b) play an important role on the pathogenesis of diabetes and periodontitis.
• Epidemiology studies generally suggest an increased risk of periodontitis among people with diabetes mellitus. Longitudinal studies also indicate that diabetes mellitus is an important risk factor for peridontitis.
  • Though some studies failed to observe the association between the degree of glycemic control and periodontitis, ^{12, 13} most studies generally support good glycemic control decreases the severity of periodontitis, while poor glycemic control increases the risk of periodontitis.
  • Other studies have reported that diabetic patients who had
  • poor glycemic control had increased risk of deep periodontal pockets, severe attachment loss, and progressive bone loss, compared to well-controlled diabetic patients. ^15–19
• It is generally accepted that production of advanced glycation endproducts (AGEs) is one of the mechanisms by which diabetes appears to affect the periodontal condition.
• There is a two-way relationship between diabetes mellitus and periodontitis, i.e. not only is diabetes a risk factor for periodontitis, but periodontitis could adversely affect diabetes mellitus.
• As inflammation can promote insulin resistance and dysregulated glycemia, ^{32, 33} it is hypothesized that periodontitis may affect glycemic control in diabetic patients.
• A number of human studies support the positive association between periodontitis and hyperlipidemia. Patients with peridontitis had higher levels of TRG, total cholesterol, and LDL than periodontally healthy controls. ^81–84 On the other hand, patients with hyperlipidemia had higher values of periodontal parameters compared to normolipidemic individuals, ^85–87 indicating that patients with hyperlipidemia are more prone to periodontal disease.
• Current evidences suggest that the association between periodontitis and hyperlipidemia is a bi-directional relationship. ⁸⁸

References

List of references (PDF)