Blood Glucose Levels and Their Association with Periodontitis Severity in Patients with Diabetes Mellitus: A Hospital-Based Cross-Sectional Study
Abstract
Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia and is associated with an increased risk of periodontal disease and greater periodontal tissue destruction. However, the relationship between blood glucose levels and the severity of periodontitis among patients with diabetes mellitus requires further evaluation in specific clinical settings. This study aimed to determine the association between blood glucose levels and periodontitis severity among patients with diabetes mellitus attending the Periodontic Polyclinic of Dr. Ramelan Naval Central Hospital, Surabaya. An analytical observational study with a cross-sectional design was conducted among 30 patients with diabetes mellitus selected using a total sampling approach. Blood glucose data were obtained from fasting or random blood glucose records documented within the preceding three months, while periodontal status was assessed clinically using the Community Periodontal Index of Treatment Needs (CPITN). Descriptive statistics were used to characterize the participants, and the association between blood glucose levels and periodontitis severity was analyzed using the Chi-square test with a significance level of 0.05. Among the participants, 17 (57%) had uncontrolled blood glucose levels, whereas 13 (43%) had controlled levels. Moderate periodontitis was the most frequently observed condition, affecting 14 participants (47%), followed by severe periodontitis in 9 (30%) and mild periodontitis in 7 (23%). The Chi-square analysis demonstrated a statistically significant association between blood glucose levels and periodontitis severity (p < 0.001). Patients with uncontrolled blood glucose levels were more frequently observed in the moderate-to-severe periodontitis categories. In conclusion, blood glucose control was significantly associated with periodontitis severity in patients with diabetes mellitus. These findings support the importance of integrating glycemic monitoring with routine periodontal assessment as part of comprehensive diabetes management.
Full text article
References
[1] A. B. Anugerah and D. B. Rahmawan, “The impact of diabetes mellitus on the development of oral diseases: A review of pathogenesis, clinical manifestations, and preventive strategies,” World J. Biol. Pharm. Health Sci., vol. 25, no. 1, pp. 59–64, 2026, doi: 10.30574/wjbphs.2026.25.1.0010.
[2] L. Zhao et al., “Diabetes and its complications: Molecular mechanisms, prevention and treatment,” Signal Transduct. Target. Ther., vol. 11, no. 1, 2026, doi: 10.1038/s41392-025-02401-w.
[3] G. Rasuna and S. Wening, “Periodontal disease risk factors in elderly and older adults with diabetes mellitus comorbidity using the PRECEDE–PROCEED framework: A cross-sectional study,” vol. 38, no. 1, pp. 21–34, 2026, doi: 10.24198/pjd.vol38no1.66984.
[4] Y. Yang, X. Sun, Y. Yang, and Y. Qie, “Insight of the interrelationship and association mechanism between periodontitis and diabetes mellitus,” Regen. Ther., vol. 26, pp. 1159–1167, 2024, doi: 10.1016/j.reth.2024.11.001.
[5] G. L. Su, Y. J. Peng, H. Z. Ruan, J. Cheng, T. Deng, and Y. F. Zhang, “Regulating periodontal disease with smart stimuli-responsive systems: Antimicrobial activity, immunomodulation, periodontium regeneration,” Mater. Today Bio, vol. 32, 2025, doi: 10.1016/j.mtbio.2025.101863.
[6] D. W. Soeatmadji, R. Rosandi, M. R. Saraswati, R. P. Sibarani, and W. O. Tarigan, “Clinicodemographic profile and outcomes of type 2 diabetes mellitus in the Indonesian cohort of DISCOVER: A 3-year prospective cohort study,” J. ASEAN Fed. Endocr. Soc., vol. 38, no. 1, pp. 68–74, 2023, doi: 10.15605/jafes.038.01.10.
[7] V. Pavithra, K. K. Sri Chinthu, and M. C. Solomon, “Diabetes mellitus, obesity and periodontitis—A three way interconnection,” Obes. Med., vol. 55, p. 100615, 2025, doi: 10.1016/j.obmed.2025.100615.
[8] A. A. Abdulkareem, F. B. Al-Taweel, A. J. B. Al-Sharqi, S. S. Gul, A. Sha, and I. L. C. Chapple, “Current concepts in the pathogenesis of periodontitis: From symbiosis to dysbiosis,” J. Oral Microbiol., vol. 15, no. 1, 2023, doi: 10.1080/20002297.2023.2197779.
[9] S. Alam, M. K. Hasan, S. Neaz, N. Hussain, M. F. Hossain, and T. Rahman, “Diabetes mellitus: Insights from epidemiology, biochemistry, risk factors, diagnosis, complications and comprehensive management,” Diabetology, vol. 2, no. 2, pp. 36–50, 2021, doi: 10.3390/diabetology2020004.
[10] J. S. Ranbhise et al., “Chronic inflammation and glycemic control: Exploring the bidirectional link between periodontitis and diabetes,” Dent. J., vol. 13, no. 3, 2025, doi: 10.3390/dj13030100.
[11] M. Zhao, Y. Xie, W. Gao, C. Li, Q. Ye, and Y. Li, “Diabetes mellitus promotes susceptibility to periodontitis—Novel insight into the molecular mechanisms,” Front. Endocrinol., vol. 14, 2023, doi: 10.3389/fendo.2023.1192625.
[12] T. Shinjo and F. Nishimura, “The bidirectional association between diabetes and periodontitis, from basic to clinical,” Jpn. Dent. Sci. Rev., vol. 60, pp. 15–21, 2024, doi: 10.1016/j.jdsr.2023.12.002.
[13] M. Martínez-García and E. Hernández-Lemus, “Periodontal inflammation and systemic diseases: An overview,” Front. Physiol., vol. 12, 2021, doi: 10.3389/fphys.2021.709438.
[14] I. Păunică et al., “The bidirectional relationship between periodontal disease and diabetes mellitus—A review,” Diagnostics, vol. 13, no. 4, 2023, doi: 10.3390/diagnostics13040681.
[15] S. Enteghad, F. Shirban, M. H. Nikbakht, M. Bagherniya, and A. Sahebkar, “Relationship between diabetes mellitus and periodontal/peri-implant disease: A contemporaneous review,” Int. Dent. J., vol. 74, no. 3, pp. 426–445, 2024, doi: 10.1016/j.identj.2024.03.010.
[16] M. Inoue et al., “Periodontal tissue susceptibility to glycaemic control in type 2 diabetes,” Diabetes Obes. Metab., vol. 26, no. 10, pp. 4684–4693, 2024, doi: 10.1111/dom.15835.
[17] Y. Zhang, S. G. Leveille, S. M. Camhi, and L. Shi, “Association of oral care with periodontitis and glycemic control among US adults with diabetes,” BMC Oral Health, vol. 23, no. 1, 2023, doi: 10.1186/s12903-023-03580-0.
[18] N. Alwithanani, “Periodontal diseases and diabetes mellitus: A systematic review,” J. Pharm. Bioallied Sci., vol. 15, no. S1, pp. S54–S63, 2023, doi: 10.4103/jpbs.jpbs_515_22.
[19] G. L. Di Domenico, M. Minoli, N. Discepoli, A. Ambrosi, and M. de Sanctis, “Effectiveness of periodontal treatment to improve glycemic control: An umbrella review,” Acta Diabetol., vol. 60, no. 1, pp. 101–113, 2023, doi: 10.1007/s00592-022-01991-z.
[20] D. W. Soeatmadji et al., “Clinicodemographic profile and outcomes of type 2 diabetes mellitus in the Indonesian cohort of DISCOVER: A 3-year prospective cohort study,” J. ASEAN Fed. Endocr. Soc., vol. 38, no. 1, pp. 68–74, 2023, doi: 10.15605/jafes.038.01.10.
[21] I. Alexa et al., “Cross-sectional comparative assessment of periodontal status in diabetic and non-diabetic individuals within a Romanian cohort,” J. Clin. Med., vol. 14, no. 22, 2025, doi: 10.3390/jcm14228199.
[22] J. R. Vandenbroucke et al., “Strengthening the reporting of observational studies in epidemiology (STROBE): Explanation and elaboration,” BMJ, vol. 335, no. 7624, pp. 806–808, 2007. [Methodological reporting guideline; although foundational, this reference is older than the requested 5-year window.]
[23] American Diabetes Association Professional Practice Committee, “4. Comprehensive medical evaluation and assessment of comorbidities: Standards of Medical Care in Diabetes—2022,” Diabetes Care, vol. 45, no. Suppl. 1, pp. S46–S59, 2022, doi: 10.2337/dc22-S004.
[24] C. Turner, “Diabetes mellitus and periodontal disease: The profession's choices,” British Dental Journal, vol. 233, no. 7, pp. 537–538, 2022, doi: 10.1038/s41415-022-5029-5.
[25] A. Alwithanani, “Periodontal diseases and diabetes mellitus: A systematic review,” Journal of Pharmacy and Bioallied Sciences, vol. 15, Suppl. 1, pp. S54–S63, 2023, doi: 10.4103/jpbs.jpbs_515_22.
[26] V. B. et al., “Glycemic control, inflammatory mediators, and periodontal health: A cross-sectional study in patients with diabetes,” 2025.
[27] A. Shahid, S. A. Khalid, M. Muneer, N. Khan, S. Iqbal, and N.-u.-Huda, “Evaluation of periodontal health in diabetic patients: Influence of glycemic control and diabetes duration using the Community Periodontal Index—A longitudinal study,” Journal of Lahore Medical and Dental College, vol. 2, no. 1, 2025, doi: 10.70384/jlmdc.v2i01.70.
[28] G. Isola et al., “Periodontal health and disease in the context of systemic diseases,” Mediators of Inflammation, vol. 2023, 2023, doi: 10.1155/2023/9720947.
[29] F. P. Crawley et al., “World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human participants,” JAMA, vol. 333, no. 1, pp. 71–74, 2025, doi: 10.1001/jama.2024.21972.
[30] G. Isola et al., "Periodontal health and disease in the context of systemic diseases," Mediators Inflamm., vol. 2023, pp. 1–12, 2023.
[31] D. Herrera et al., "Association between periodontal diseases and cardiovascular diseases, diabetes and respiratory diseases: Consensus report of the Joint Workshop by the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe)," J. Clin. Periodontol., vol. 50, no. 6, pp. 819–841, 2023.
[32] S. Utami, "Effect of diabetes mellitus as a modifier with periodontitis severity and oral health – related quality of life in older adults: A cross-sectional study," Padjadjaran J. Dent., vol. 38, no. 1, pp. 35–43, 2026.
[33] International Pharmaceutical Federation (FIP), "Diabetes prevention, screening, and management: A handbook for pharmacists," Int. Pharm. Fed., The Hague, Netherlands, 2021.
[34] Y. Zhang, S. G. Leveille, S. M. Camhi, and L. Shi, "Association of oral care with periodontitis and glycemic control among US adults with diabetes," BMC Oral Health, vol. 23, no. 1, pp. 1–9, 2023.
[35] G. P. Alvaro, M. N. K. Angelina, R. C. J. Adelina, R. G. K. Guadalupe, and J. N. J. Cuauhtémoc, "Oral hygiene status, tooth loss, and periodontal disease severity in Mexican adults: A cross-sectional study," Int. J. Dent., vol. 2026, pp. 1–8, 2026.
[36] N. Shi et al., "The bidirectional relationship between periodontitis and diabetes: New prospects for stem cell-derived exosomes," Biomed. Pharmacother., vol. 165, p. 115219, 2023.
Authors
Copyright (c) 2026 Nopi Nekawati, Sri Hidayati, Ratih Larasati, Isnanto
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlikel 4.0 International (CC BY-SA 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).