Diabetes Mellitus and its Sixth Complication Explained

In 1999 Löe described periodontal disease (PD) as the sixth complication of diabetes mellitus (DM) because this latter group of patients has a 3 – 4 times greater risk of developing PD when compared with non-diabetics. This rises to 10 times for smokers. DM and PD are inter-related, one disease affecting the other and vice versa. The exact mechanism is unclear but may be related to inflammation, blood markers for which are raised in both diseases. From the medical point of view there are five complications of DM namely cardiac, vascular, renal, ophthalmic and neurological that can be visualised as a simple hub called DM with spokes for the above complications. However, the research evidence has shown that the severity of all these five complications is worse when patients have active, uncontrolled PD. When PD is treated, there is an improvement in glycaemic control. These results have led to the conclusion that PD is not a separate complication of DM but a co-morbidity factor acting by: modifying the severity of another disease and modulating the severity of diabetic complications in the manner of a rheostat. A new model is proposed together with a system for doctors and dentists to work together. There are likely to be wide variations in outcomes depending on both the bacteriological load from mature dental plaque and individual immune responses. More focussed research is required.