Published online Sep 15, 2024. doi: 10.4239/wjd.v15.i9.1842
Revised: June 13, 2024
Accepted: June 19, 2024
Published online: September 15, 2024
Processing time: 151 Days and 23.7 Hours
The bidirectional relationship between periodontitis and type 2 diabetes mellitus has been well-established. However, the underlying molecular mechanisms remain unclear. Diabetic retinopathy (DR) is an important complication of dia
Core Tip: This editorial elucidates the significant link between periodontitis and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus. By examining the inflammatory pathways shared by both conditions, we highlight how periodontal inflammation not only exacerbates systemic inflammation but also contributes to vascular complications typical of DR. The study underscores the clinical implications of incorporating periodontal care into the management of diabetes, and advocates integrated treatment approaches to enhance patient outcomes.
- Citation: Zhao Y, Shen QQ. Link between periodontitis and diabetic retinopathy: Inflammatory pathways and clinical implications. World J Diabetes 2024; 15(9): 1842-1846
- URL: https://www.wjgnet.com/1948-9358/full/v15/i9/1842.htm
- DOI: https://dx.doi.org/10.4239/wjd.v15.i9.1842
Diabetes mellitus (DM) is a challenging chronic disease that affects millions worldwide, leading to complications such as microvascular damage and diabetic retinopathy (DR), a primary cause of blindness[1,2]. Periodontitis is present in app
Periodontitis, a chronic inflammatory non-communicable disease, is characterized by the destruction of periodontal tis
Mechanisms through which periodontitis negatively impacts T2DM include bacteremia, vascular inflammation, sys
Conversely, it is also understood that diabetes is a risk factor for periodontitis. Previous studies have demonstrated that individuals with diabetes are more susceptible to periodontal disease and have faster progression of periodontitis compared to non-diabetics[7,18,24-26]. Effective glycemic control, even without periodontal treatment, can improve probing bleeding in patients. Additionally, patients with well-managed diabetes have shown a significant reduction in the progression of periodontal disease over 5 years[27]. The mechanisms leading to poor periodontal outcomes in patients with diabetes and hyperglycemia include excessive systemic inflammation, reduced neutrophil functional efficiency, imbalanced T-helper cell responses, and inhibition of periodontal wound healing due to the formation of advanced glycation end-products (AGEs)[28].
DR, as a microvascular complication of diabetes, leads to significant visual impairment and blindness among the diabetic population. Research indicates that T2DM patients with periodontitis have an increased risk of developing DR compared to those without periodontitis[29]. Furthermore, a positive correlation exists between the severity of DR and the severity of periodontitis[24,30]. Given the established link between periodontitis and DR, it is critical to determine the underlying mechanisms connecting these two conditions.
The interconnection between DR and periodontitis underscores a complex interplay of pathophysiological mechanisms primarily mediated through systemic inflammation and endothelial dysfunction. Both conditions share a commonality in their pathogenesis, rooted in the systemic inflammatory response and oxidative stress, which serve as pivotal links in their association. In the context of diabetes, hyperglycemia-induced oxidative stress, and the formation of AGEs play a critical role in endothelial dysfunction, a hallmark of microvascular complications including DR[31]. Endothelial dysfun
Similarly, periodontitis, characterized by persistent oral infection and inflammation, contributes to the systemic inflammatory burden through the dissemination of pro-inflammatory cytokines such as tumor necrosis factor-alpha, IL-6, and C-reactive protein into the systemic circulation[10,16,33]. These inflammatory mediators can further impair endothelial function, thus potentially exacerbating the microvascular complications of diabetes[34]. Moreover, under the influence of inflammation, periodontitis can also lead to dyslipidemia, atherosclerosis, and aggravation of retinal hypoxia, leading to neovascularization and promoting the progression of DR[30].
Furthermore, the increased systemic inflammatory response in patients with periodontitis may exacerbate insulin resistance, a key feature of T2DM, thereby worsening glycemic control. Poor glycemic control, in turn, can accelerate the progression of DR through mechanisms such as increased oxidative stress, upregulation of inflammatory pathways, and vascular endothelial growth factor production, which promotes neovascularization and the progression of DR[34,35].
Although the proposed mechanisms offer plausible explanations, the current evidence base underpinning the association between DR and periodontitis is deemed to be of low quality[36]. Direct verification of these mechanisms is also lacking, signifying the necessity for augmented research efforts. There is a critical need for future studies characterized by larger sample sizes, enhanced models for adjusting confounders, and the adoption of prospective analyses to elucidate the relationship between these conditions more clearly.
In recent years, the intricate interplay between periodontitis and DR among individuals with T2DM has garnered sig
The findings revealed a significantly higher proportion of periodontitis, severity of periodontitis, clinical attachment loss (CAL), PISA, IL-6, and Lp(a) in T2DM subjects with DR compared to those without DR, underscoring a pronounced inflammatory burden in subjects with concomitant DR. Notably, HbA1c exhibited a positive correlation with CAL and PISA, highlighting the intricate link between glycemic control, periodontal inflammation, and diabetic complications.
The study’s implications are manifold. Firstly, it underscores the necessity of integrating periodontal care into the dia
This manuscript is not without limitations. Firstly, the study is limited by a relatively small sample size and a failure to control for some key confounding factors related to periodontitis and DR, leading to insufficient evidence. Secondly, the cross-sectional design complicates the elucidation of potential mechanisms linking periodontitis with diabetes-associated microvascular complications, underscoring the need for further prospective and mechanistic research to clarify the associations or causal relationships.
The potential pathophysiological mechanisms linking periodontitis and DR involve a complex interplay of systemic inflammation, endothelial dysfunction, oxidative stress, and exacerbated insulin resistance. This bidirectional relationship underscores the need for comprehensive management strategies in diabetic patients, targeting both glycemic control and periodontal health, to mitigate the progression of DR and improve overall vascular health. Further investigation into the specific inflammatory markers and cytokines involved in both diseases could illuminate potential therapeutic targets.
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