Clinical attachment loss is cross-sectionally associated with elevated glucose among adults without diabetes

Hamdi S. Adam, Rebecca Molinsky, Bruno Bohn, Sumith Roy, Michael Rosenbaum, Bruce Paster, Melana Yuzefpolskaya, Paolo C. Colombo, Panos N. Papapanou, Moïse Desvarieux, David R. Jacobs, Ryan T. Demmer

Research output: Contribution to journalArticlepeer-review


Aim: We investigated whether periodontal measures are cross-sectionally associated with prediabetes and cardiometabolic biomarkers among non-diabetic younger adults. Materials and Methods: One thousand seventy-one participants (mean age = 32.2 years [SE = 0.3]; 73% female) from the Oral Infections, Glucose Intolerance and Insulin Resistance Study were enrolled. Full-mouth clinical attachment loss (fm-CAL), probing depth (fm-PD) and bleeding on probing were ascertained. Interproximal CAL (i-CAL) and probing depths (i-PD) served as our primary exposures. Glucose, HbA1c, insulin and insulin resistance (HOMA-IR) outcomes were assessed from fasting blood. Prediabetes was defined per American Diabetes Association guidelines. Prediabetes prevalence ratios (PR [95% CI]) and mean [SE] cardiometabolic biomarkers were regressed on periodontal variables via multivariable robust variance Poisson regression or multivariable linear regression. Results: Prevalence of prediabetes was 12.5%. Fully adjusted prediabetes PR in Tertiles 3 versus 1 of mean i-CAL was 2.42 (1.77, 3.08). Fully adjusted fasting glucose estimates across i-CAL tertiles were 83.29 [0.43], 84.31 [0.37], 86.48 [0.46]; p for trend <.01. Greater percent of sites with i-PD ≥3 mm showed elevated natural-log-HOMA-IR after adjustment (0%–12% of sites = 0.33 [0.03], 13%–26% of sites = 0.39 [0.03], ≥27% of sites = 0.42 [0.03]; p for trend =.04). Conclusions: i-CAL (vs. fm-CAL) was associated with elevated fasting glucose and prediabetes, whereas i-PD (vs. fm-PD) was associated with insulin resistance. Future studies are needed to examine periodontal disease and incident prediabetes.

Original languageEnglish (US)
Pages (from-to)522-535
Number of pages14
JournalJournal of clinical periodontology
Issue number5
StateAccepted/In press - 2024

Bibliographical note

Publisher Copyright:
© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


  • HbA1c
  • biomarkers
  • epidemiology
  • glucose
  • insulin
  • periodontitis
  • prediabetes


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