Conflicting evidence suggests a link between diabetes-related microvascular complications and periodontitis. Reliable estimates have been hindered by small sample sizes and residual confounding. Moreover, the combined effects of microvascular complications and dyslipidemia on periodontitis have not been explored. Therefore, this study aimed to investigate the association between individual and combined diabetic microvascular complications (i.e., neuropathy and retinopathy) and moderate/severe periodontitis in a Danish population-based study. In addition, we assessed whether dyslipidemia modified these associations. This study comprised 15,922 participants with type 2 diabetes from the Health in Central Denmark study. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for individual and joint microvascular diabetes complications. The models adjusted for potential confounders, including sociodemographic factors, lifestyle behaviors, and health conditions. Inverse probability of treatment weighting (IPTW) balanced measured confounders between periodontitis and nonperiodontitis participants. Sensitivity analyses tested the findings’ robustness by estimating E-values for unmeasured confounding and varying microvascular complication definitions. After IPTW, adjusted models revealed that diabetic neuropathy (OR 1.36, 95% CI 1.14 to 1.63) and retinopathy (OR 1.21, 95% CI 1.03 to 1.43) were significantly associated with moderate/severe periodontitis. Moreover, the coexistence of microvascular complications increased the odds 1.5-fold for moderate/severe periodontitis (OR 1.51, 95% CI 1.23 to 1.85). An effect modification of dyslipidemia on an additive scale was found, indicated by a positive relative excess risk due to interaction of 0.24 for neuropathy, 0.11 for retinopathy, and 0.44 for both complications. Sensitivity analysis ruled out unmeasured confounders and microvascular complication definitions as explanatory factors. Diabetic neuropathy and retinopathy, individually and combined, were associated with moderate/severe periodontitis. In addition, dyslipidemia had an additive positive effect modification on diabetic microvascular complications, elevating the odds of moderate/severe periodontitis. These findings may aid in identifying at-risk subgroups for diabetes-related microvascular complications and periodontitis, optimizing efforts to mitigate disease burden.

中文翻译：

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牙周炎和糖尿病并发症：一项基于丹麦人群的研究


相互矛盾的证据表明糖尿病相关的微血管并发症和牙周炎之间存在联系。样本量小和残留混杂因素阻碍了可靠的估计。此外，微血管并发症和血脂异常对牙周炎的综合影响尚未被探索。因此，本研究旨在在一项基于丹麦人群的研究中探讨个体和联合糖尿病微血管并发症（即神经病变和视网膜病变）与中度/重度牙周炎之间的关联。此外，我们还评估了血脂异常是否改变了这些关联。这项研究由来自丹麦中部健康研究的 15,922 名患有 2 型糖尿病的参与者组成。使用多项逻辑回归来估计个体和关节微血管糖尿病并发症的比值比 (OR) 和 95% 置信区间 (CI)。这些模型针对潜在的混杂因素进行了调整，包括社会人口因素、生活方式行为和健康状况。治疗加权逆概率 (IPTW) 平衡了牙周炎和非牙周炎参与者之间的测量混杂因素。敏感性分析通过估计未测量的混杂因素和不同微血管并发症定义的 E 值来测试研究结果的稳健性。 IPTW后，调整模型显示糖尿病神经病变（OR 1.36，95% CI 1.14至1.63）和视网膜病变（OR 1.21，95% CI 1.03至1.43）与中度/重度牙周炎显着相关。此外，微血管并发症的共存使中度/重度牙周炎的几率增加了1.5倍（OR 1.51，95% CI 1.23至1.85）。 发现了血脂异常在加性尺度上的效应修正，表现为由于神经病变 0.24、视网膜病变 0.11 和两种并发症 0.44 的相互作用而导致的正相对超额风险。敏感性分析排除了未测量的混杂因素和微血管并发症的定义作为解释因素。糖尿病神经病变和视网膜病变，无论是单独的还是联合的，都与中度/重度牙周炎相关。此外，血脂异常对糖尿病微血管并发症具有附加的积极影响，增加了中度/重度牙周炎的几率。这些发现可能有助于识别糖尿病相关微血管并发症和牙周炎的高危亚组，从而优化减轻疾病负担的努力。