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Periodontitis may be an early sign of type 2 diabetes

24 February 2017

Periodontitis may be an early sign of type 2 diabetes
A new study suggests severe gum disease - also known as periodontitis - may be an early marker of type 2 diabetes.

New research suggests there may be a link between gum disease and diabetes.

According to the latest data, diabetes affects approximately 422 million people worldwide, and this number is expected to increase.

In the United States, 29 million people live with the disease. Of these, over 8 million people have it but have not been diagnosed, according to the Centers for Disease Control and Prevention (CDC).

The CDC also estimate that 37 percent of American adults over the age of 20 have prediabetes.

New research - published in the journal BMJ Open Diabetes Research & Care - suggests severe gum disease, or periodontitis, might be an early sign of diabetes.

The authors also suggest a simple finger stick diabetes screening procedure could be carried out in the dental office to avoid the adverse effects of leaving diabetes untreated.

"[The findings confirm] the assumption that severe periodontitis could be an early sign of undiagnosed diabetes [...] The early diagnosis and intervention of prediabetes prevent the common microvascular and macrovascular complications and are cost-effective."

Studying the link between severe gum disease and diabetes

Researchers from the University of Amsterdam in The Netherlands assessed a total of 313 participants from a dental clinic at the university.

Of these, 126 patients had mild-to-moderate gum disease, 78 patients had severe periodontitis, and 198 individuals did not have signs of gum disease.

Participants with periodontitis had a higher body mass index (BMI) than the rest, with an average BMI of 27. However, other diabetes risk factors - such as high blood pressure or high cholesterol - were similar across all three groups.

The researchers analyzed higher glycated hemoglobin (HbA1c) values in dry blood spots, and evaluated the differences in mean HbA1c values, as well as the prevalence of diabetes and prediabetes between the two groups.

HbA1c values measure the average level of blood sugar in the last 2-3 months. The dry blood spots were obtained by sampling participants' blood using a finger pin-prick test.

Prediabetes is commonly considered to range between an HbA1C value of 39-47 millimoles per mol (mmol/mol).

Most diabetes cases found among those with periodontitis

The analysis revealed that those with the most severe form of periodontitis also had the highest HbA1c values.

The average HbA1c values for the severe gum disease group was 45 mmol/mol, compared with 43 mmol/mol in those with mild-to-moderate gum disease and 39 mmol/mol among those without gum disease.

Additionally, the researchers found a high percentage of people with suspected diabetes and prediabetes among participants with mild-to-moderate as well as severe gum disease.

In the severe gum disease group, 23 percent of study participants were suspected of diabetes, whereas 14 percent of the mild-to-moderate gum disease participants had suspected diabetes. In the severe gum disease group, 47 percent had prediabetes, and 46 percent of those in the mild-to-moderate group had prediabetes.

By comparison, 37 percent of those with no gum disease had prediabetes, and 10 percent had suspected diabetes.

Additionally, the researchers found previously undiagnosed cases of diabetes across the three groups: 8.5 percent of those with no gum disease and a little under 10 percent of those with mild-to-moderate gum disease had not been previously diagnosed with the disease until the study.

As much as 18 percent of those with severe gum disease had not been diagnosed with diabetes.

The study is observational, so it cannot explain a causal link between gum disease and diabetes. However, the authors suggest that screening patients with severe periodontitis for diabetes as part of dental medical practices might be an effective way of avoiding complications of the disease. The authors conclude:

Anorexia 'improved by electrode therapy'

Deep brain stimulation - implanting electrodes deep in the brain - could be a new way to treat severe anorexia nervosa, a Canadian study suggests.

Scientists studied 16 people with severe anorexia and found the treatment helped reduce depression and anxiety and in some cases prompted weight gain.

Researchers say further, larger studies are needed before the therapy could be considered more widely.

The study appears in the journal Lancet Psychiatry.

The research involved women aged between 21 and 57 who had had anorexia for an average of 18 years and had tried all other available treatment.

The women were severely underweight and researchers say some were at a risk of dying early because of the condition.

At the beginning of the study, electrodes were placed in specific areas of their brains, thought to be linked to anorexia.

Within a few months, some patients felt symptoms of depression and anxiety had improved.

And 12 months later, a number of the patients had gained weight.

The average body mass index of the group increased from 13.8 to 17.3.

Researchers also looked at brain scans before and after a year of electrical stimulation and found persistent changes in the areas linked to anorexia.

Dr Nir Lipsman, a neurosurgeon at the Sunnybrook Health Sciences Center, told the BBC: "There are currently no effective treatments for people with long-standing anorexia nervosa - people who are often the sickest and most vulnerable of dying from the condition.

"Our work, which builds on earlier trials, is one of the first brain-based strategies that has been shown to help with chronic anorexia.

"And my hope is that through this research we are also validating the idea that anorexia is a brain-based illness, not a personality or lifestyle choice."

But he accepted the treatment did not suit everyone in the trial.

One patient had a seizure several months after electrode implantation, and two people asked for their electrodes to be removed during the trial.

Writing in the same journal, Dr Carrie McAdams, of the University of Texas Southwestern, said: "Further work to establish efficacy, safety and long-term outcomes in a larger cohort is needed."

Prof Rebecca Park, of the Royal College of Psychiatrists said: "While these results are encouraging, we must remember that deep brain stimulation for anorexia nervosa is a high risk, experimental treatment.

"In Oxford, we are running the sole registered UK trial of this kind.

"Central to our work is the development of an ethical standard that ensures vulnerable individuals are not inadvertently exploited by this treatment."

Fasting diet 'regenerates diabetic pancreas'

The pancreas can be triggered to regenerate itself through a type of fasting diet, say US researchers.

Restoring the function of the organ - which helps control blood sugar levels - reversed symptoms of diabetes in animal experiments.

The study, published in the journal Cell, says the diet reboots the body.

Experts said the findings were "potentially very exciting" as they could become a new treatment for the disease.

The experiments were on mice put on a modified form of the "fasting-mimicking diet".

When people go on it they spend five days on a low calorie, low protein, low carbohydrate but high unsaturated-fat diet.

It resembles a vegan diet with nuts and soups, but with around 800 to 1,100 calories a day.

Then they have 25 days eating what they want - so overall it mimics periods of feast and famine.

Previous research has suggested it can slow the pace of ageing.

But animal experiments showed the diet regenerated a special type of cell in the pancreas called a beta cell.

These are the cells that detect sugar in the blood and release the hormone insulin if it gets too high.

Dr Valter Longo, from the University of Southern California, said: "Our conclusion is that by pushing the mice into an extreme state and then bringing them back - by starving them and then feeding them again - the cells in the pancreas are triggered to use some kind of developmental reprogramming that rebuilds the part of the organ that's no longer functioning."

There were benefits in both type 1 and type 2 diabetes in the mouse experiments.

Type 1 is caused by the immune system destroying beta cells and type 2 is largely caused by lifestyle and the body no longer responding to insulin.

Further tests on tissue samples from people with type 1 diabetes produced similar effects.

Dr Longo said: "Medically, these findings have the potential to be very important because we've shown - at least in mouse models - that you can use diet to reverse the symptoms of diabetes.

"Scientifically, the findings are perhaps even more important because we've shown that you can use diet to reprogram cells without having to make any genetic alterations."

Separate trials of the diet in people have been shown to improve blood sugar levels. The latest findings help to explain why.

However, Dr Longo said people should not rush off and crash diet.

He told the BBC: "It boils down to do not try this at home, this is so much more sophisticated than people realise."

He said people could "get into trouble" with their health if it was done without medical guidance.

Dr Emily Burns, research communications manager at Diabetes UK, said: "This is potentially very exciting news, but we need to see if the results hold true in humans before we'll know more about what it means for people with diabetes.

"People with type-1 and type-2 diabetes would benefit immensely from treatments that can repair or regenerate insulin-producing cells in the pancreas."


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