Does periodontitis affect diabetes incidence and haemoglobin A1c change? An 11-year follow-up study

Research output: Contribution to journalArticlepeer-review


  • T. G. Kebede
  • C. Pink
  • W. Rathmann
  • B. Kowall
  • H. Völzke
  • A. Petersmann
  • P. Meisel
  • T. Kocher
  • B. Holtfreter

Colleges, School and Institutes

External organisations

  • Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald
  • German Diabetes Centre, Institute for Biometrics and Epidemiology
  • Center for Clinical Epidemiology, c/o Institute for Clinical Informatics, Biometry and Epidemiology (IMIBE), University Hospital
  • Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald
  • German Centre for Diabetes Research (DZD)
  • Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald


Aim: As periodontitis may contribute to the pathogenesis of diabetes, the effects of periodontitis on diabetes incidence and HbA1c change was quantified in a prospective cohort.

Methods: Data from an 11-year follow-up of the Study of Health in Pomerania were analyzed to evaluate the effects of periodontitis on incident diabetes and long-term HbA1c changes in 2047 subjects aged 20–81 years. Diabetes was based on self-reported physician diagnoses, antidiabetic medication use, or HbA1c ≥ 6.5% or non-fasting blood glucose levels ≥ 11.1 mmol/L. To assess periodontal status, periodontal pockets were probed, and their depth and clinical attachment levels measured. For both measures, means and percentages of sites ≥ 3 mm were calculated. In addition, all probing depths ≥ 4 mm were summed (cumulative probing depth). Modified Poisson and multivariable linear models were applied, adjusted for age, gender, highest level of general education, marital status, waist circumference, physical activity, smoking status and follow-up time.

Results: Over a mean follow-up period of 11.1 years, 207 subjects developed diabetes. Baseline mean clinical attachment levels (CAL) and probing depths (PPD) were not significantly associated with either diabetes incidence [mean CALs, fourth quartile, incidence rate ratio = 0.819, 95% confidence interval (CI): 0.489–1.370; P = 0.446] or long-term changes in HbA1c (mean CAL, fourth quartile, β = −0.086, 95% CI: −0.187, −0.016; P = 0.098). Sensitivity analyses using alternative exposure definitions confirmed these results.

Conclusion: Contrary to the currently available literature, no convincing evidence was found of any potential association between periodontitis and diabetes incidence or HbA1c change.


Original languageEnglish
JournalDiabetes & Metabolism
Early online date22 Nov 2017
Publication statusE-pub ahead of print - 22 Nov 2017


  • chronic periodontitis , cohort studies , diabetes mellitus , haemoglobin A1c , incidence , progression , study of health in Pomerania

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