title: Periodontal disease as a potential risk factor for the development of diabetes in women with a prior history of gestational diabetes mellitus.
abstract: OBJECTIVE
  To examine if periodontal disease is associated with later development of impaired glucose metabolism in women with a recent history of gestational diabetes (GDM).
  
  
  METHODS
  Women with (n = 19) and without (n = 20) a history of GDM were prospectively followed at 22 months postpartum. All subjects underwent: a) a 75-gram oral glucose tolerance test (OGTT); and b) an oral examination for measuring periodontal disease. Insulin sensitivity and pancreatic β-cell secretory capacity derived from fasting (HOMA-IR) and glucose-stimulated measures (SI(OGTT) and IGI/HOMA-IR) were determined. Periodontitis was defined as the presence of any site with a probing depth ≥ 4 mm or a clinical attachment loss ≥ 4 mm.
  
  
  RESULTS
  Compared to women without a history of GDM, prior GDM women had significantly higher fasting glucose and insulin concentrations, increased insulin resistance and decreased β-cell function. Although not statistically significant, prior GDM women had a higher prevalence of periodontal disease (42.1%) than women without a history of GDM (25.0%). Women with periodontal disease showed greater insulin resistance and lower β-cell function. Women with both prior GDM and periodontal disease had the most impaired glucose metabolism; the insulin secretion-sensitivity index was significantly lower in women with both prior GDM and periodontal disease (208.20 ± 2.60) than in women without prior GDM and periodontal disease (742.93 ± 1.78) (P < 0.05).
  
  
  CONCLUSIONS
  Women with prior GDM show reduced insulin sensitivity and inadequate β-cell secretory function at 22 months postpartum. Periodontal disease may contribute to their impaired glucose metabolism and future risk of developing diabetes.
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
authors.forename: Xu
authors.initials: X
authors.lastname: Xiong
authors.forename: Karen E
authors.initials: KE
authors.lastname: Elkind-Hirsch
authors.forename: Yiqiong
authors.initials: Y
authors.lastname: Xie
authors.forename: Robert
authors.initials: R
authors.lastname: Delarosa
authors.forename: Pooja
authors.initials: P
authors.lastname: Maney
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pridjian
authors.forename: Pierre
authors.initials: P
authors.lastname: Buekens
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000209:etiology*; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005215:Fasting / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000209:etiology*; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology; D000078790:Insulin Secretion; D050417:Insulin-Secreting Cells / Q000378:metabolism; D017622:Periodontal Attachment Loss / Q000150:complications; D010510:Periodontal Diseases / Q000150:complications*; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000150:complications; D010518:Periodontitis / Q000150:complications; D049590:Postpartum Period / Q000378:metabolism; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D007328:Insulin