Plasma levels of tumour necrosis factor-alpha in patients with chronic periodontitis and type 2 diabetes.
OBJECTIVE
Studies suggest that elevated circulating tumour necrosis factor-alpha (TNF-alpha) may contribute to insulin resistance in patients with type 2 diabetes. The source of plasma TNF has been thought to be adipocytes associated with obesity, but inflammation and infection result in TNF-alpha production as well.


METHODS
We studied 46 patients with type 2 diabetes and chronic periodontitis to determine the relationship between plasma TNF-alpha levels and clinical measures of periodontitis, gingival crevicular fluid (GCF) interleukin-1beta (IL-1beta), plasma endotoxin, serum glucose, and glycated haemoglobin (HbA1c). TNF-alpha levels were measured using a high sensitivity enzyme-linked immunosorbent assay.


RESULTS
TNF-alpha showed a significant positive correlation with attachment loss (r=0.40, p=0.009), plasma endotoxin (r=0.33, p=0.03), and GCF IL-1beta (r=0.33, p=0.035), but not probing depth (r=0.28, p=0.07), bleeding on probing (r=0.30, p=0.053), plaque index (r=0.22, p=0.17), serum glucose, HbA1c (r=0.10, p=0.50), or body mass index (r=0.077, p=0.62). A dose-response relationship was observed between periodontitis severity and TNF-alpha (p=0.012).


CONCLUSIONS
The finding that chronic periodontitis is associated with plasma TNF-alpha levels in subjects with type 2 diabetes supports the hypothesis that periodontal infection and inflammation may contribute to insulin resistance.
Engebretson
S
S
Department of Periodontics, School of Dental Medicine, Stony Brook University, Stony Brook, NY 11794, USA. sengebretson@notes.cc.sunysb.edu
Chertog
R
R
Nichols
A
A
Hey-Hadavi
J
J
Celenti
R
R
Grbic
J
J
D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003774:Dental Plaque Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D004731:Endotoxins / Q000097:blood; D005260:Female; D005883:Gingival Crevicular Fluid / Q000276:immunology; D005884:Gingival Hemorrhage / Q000097:blood; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007333:Insulin Resistance; D053583:Interleukin-1beta / Q000032:analysis / Q000097:blood; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000097:blood; D010514:Periodontal Pocket / Q000097:blood; D010518:Periodontitis / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
D001786:Blood Glucose; D004731:Endotoxins; D006442:Glycated Hemoglobin; D053583:Interleukin-1beta; D014409:Tumor Necrosis Factor-alpha