COBRE P5: RELATIONSHIP BETWEEN PERIODONTAL DISEASE AND TYPE 2 DIABETES

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. It is established that the prevalence, severity and progression of periodontal disease is increased in patients with diabetes. African Americans have a disproportionate burden of diabetes and periodontal disease. The overall prevalence of periodontal disease for NHANES III population was 7.3%, with non-diabetic African Americans exhibiting the highest prevalence (11.4%). As compared to the national figures, the type 2 diabetic Gullah-speaking African American studied by Dr. J. Fernandes had a very high prevalence of periodontal disease (70.64%). Type 2 diabetes mellitus and periodontal disease are public health problems among Gullah-speaking African Americans. In this population higher glycated hemoglobin A1c (HbA1c) is associated with increasing proportion of teeth with higher clinical attachment loss (CAL). Diabetes clearly increases the risk for periodontal diseases, but less clear is the impact of periodontal diseases on glycemic control of diabetes and the mechanisms through which this occurs. It is possible that periodontal diseases may serve as initiators or propagators of insulin resistance in a way similar to obesity, thereby complicating glycemic control. Matrix metalloproteinases (MMPs) are responsible for tissue degradation and bone resoption. Of these, MMP-8 in gingival crevicular fluid (GCF) is the most prominent collagenase associated with periodontitis. In contrast to healthy patients, gingival extracts of untreated gingival tissue and GCF from periodontitis patients contain pathologically elevated levels of collagenase-2 (MMP-8) in the catalytically active form (aMMP-8). Analysis of GCF could provide a useful noninvasive means to assess and monitor the pathophysiological status of the periodontium tissue in a site-specific manner. The purpose of this research project is to test the hypothesis that treatment of periodontal disease is associated with better diabetes glycemic control (HbA1c) and lower levels of the catalytically active form of MMP-8 in the Gullah-speaking African American patients. We will conduct an interventional study on this population with minimal genetic admixture, living on the Sea Islands of the South Carolina coast. Specific Aim 1: To demonstrate that periodontal disease progression on poorly controlled Type 2 diabetic Gullah patients is more severe than on well-controlled patients. Specific Aim 2: To assess the effects of periodontal therapy on the level of glycemic control in the Gullah population. Specific Aim 3: To assess the concentration of the catalytically active form of MMP-8 at baseline (prior to periodontal intervention) and 3 and 6 months later.