title: Periodontal disease and mortality in type 2 diabetes.
abstract: OBJECTIVE
  Periodontal disease may contribute to the increased mortality associated with diabetes.
  
  
  METHODS
  In a prospective longitudinal study of 628 subjects aged > or =35 years, we examined the effect of periodontal disease on overall and cardiovascular disease mortality in Pima Indians with type 2 diabetes. Periodontal abnormality was classified as no or mild, moderate, and severe, based on panoramic radiographs and clinical dental examinations.
  
  
  RESULTS
  During a median follow-up of 11 years (range 0.3-16), 204 subjects died. The age- and sex-adjusted death rates for all natural causes expressed as the number of deaths per 1,000 person-years of follow-up were 3.7 (95% CI 0.7-6.6) for no or mild periodontal disease, 19.6 (10.7-28.5) for moderate periodontal disease, and 28.4 (22.3-34.6) for severe periodontal disease. Periodontal disease predicted deaths from ischemic heart disease (IHD) (P trend = 0.04) and diabetic nephropathy (P trend < 0.01). Death rates from other causes were not associated with periodontal disease. After adjustment for age, sex, duration of diabetes, HbA1c, macroalbuminuria, BMI, serum cholesterol concentration, hypertension, electrocardiographic abnormalities, and current smoking in a proportional hazards model, subjects with severe periodontal disease had 3.2 times the risk (95% CI 1.1-9.3) of cardiorenal mortality (IHD and diabetic nephropathy combined) compared with the reference group (no or mild periodontal disease and moderate periodontal disease combined).
  
  
  CONCLUSIONS
  Periodontal disease is a strong predictor of mortality from IHD and diabetic nephropathy in Pima Indians with type 2 diabetes. The effect of periodontal disease is in addition to the effects of traditional risk factors for these diseases.
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Disease, Phoenix, Arizona, USA.
authors.forename: Aramesh
authors.initials: A
authors.lastname: Saremi
authors.forename: Robert G
authors.initials: RG
authors.lastname: Nelson
authors.forename: Marshall
authors.initials: M
authors.lastname: Tulloch-Reid
authors.forename: Robert L
authors.initials: RL
authors.lastname: Hanson
authors.forename: Maurice L
authors.initials: ML
authors.lastname: Sievers
authors.forename: George W
authors.initials: GW
authors.lastname: Taylor
authors.forename: Marc
authors.initials: M
authors.lastname: Shlossman
authors.forename: Peter H
authors.initials: PH
authors.lastname: Bennett
authors.forename: Robert
authors.initials: R
authors.lastname: Genco
authors.forename: William C
authors.initials: WC
authors.lastname: Knowler
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001130:Arizona / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000401:mortality; D005260:Female; D006801:Humans; D007198:Indians, North American; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010510:Periodontal Diseases / Q000401:mortality*