Diabetic Retinopathy and Periodontitis: Implications from a Systematic Review and Meta-Analysis

Sukumaran Anil; Betsy Joseph; Merlyn Anjali Pereira; Saket Arya; Shirmila Syamala; Vishnupriya K Sweety; Ruwan Jayasinghe

doi:10.1016/j.identj.2024.10.016

Diabetic Retinopathy and Periodontitis: Implications from a Systematic Review and Meta-Analysis

Int Dent J. 2024 Nov 25:S0020-6539(24)01570-3. doi: 10.1016/j.identj.2024.10.016. Online ahead of print.

Authors

Sukumaran Anil¹, Betsy Joseph², Merlyn Anjali Pereira³, Saket Arya³, Shirmila Syamala⁴, Vishnupriya K Sweety⁵, Ruwan Jayasinghe⁶

Affiliations

¹ Oral Health Institute, Hamad Medical Corporation, Doha, Qatar; College of Dental Medicine, Qatar University, Doha, Qatar. Electronic address: drsanil@gmail.com.
² Department of Periodontology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; Pushpagiri Institute of Medical Sciences and Research Centre, Medicity, Thiruvalla, Kerala, India.
³ Department of Ophthalmology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
⁴ Hamad Medical Corporation, Doha, Qatar.
⁵ Pushpagiri Institute of Medical Sciences and Research Centre, Medicity, Thiruvalla, Kerala, India.
⁶ Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka.

PMID: 39592324
DOI: 10.1016/j.identj.2024.10.016

Abstract

Background: Diabetes mellitus, a chronic metabolic disorder affecting millions worldwide, is associated with microvascular complications, including diabetic retinopathy (DR) and periodontitis. Understanding their interrelationship is crucial for comprehensive patient care.

Objective: This systematic review and meta-analysis aim to investigate the association between DR and periodontitis in patients with Type 1 and Type 2 diabetes.

Methodology: Using the PECO framework, we searched PubMed/MEDLINE, Scopus, EMBASE, Google Scholar, and Web of Science databases (Inception to April 2023) for studies on the association between DR and periodontitis. Ten studies (n = 1828 participants), including observational and cross-sectional studies, met the inclusion criteria. We conducted qualitative synthesis, risk of bias analysis using the ROBINS-E tool, Grading of Recommendations, Assessment, Development, and Evaluations assessment (GRADE), and random-effects meta-analysis.

Results: Eight studies found a significant association between severe periodontitis (pocket depth ≥5 mm) and DR, while two found no association. Meta-analysis of 843 participants showed diabetics with periodontitis had 4.48 times higher odds (95% confidence interval: 1.67-12.07, P = .003) of developing retinopathy compared to diabetics without periodontitis. High heterogeneity was observed (I² = 86%). Subgroup analysis by diabetes type showed no significant difference. The overall GRADE level of evidence was very low.

Conclusion: While most included studies suggest an association between severe periodontitis and increased DR risk, the overall certainty of evidence is low. These findings highlight the potential importance of periodontal health in diabetic patients. High-quality longitudinal studies with adequate control of confounders are required to determine if periodontitis contributes to the progression of DR or if the conditions are merely coincidentally related.

Keywords: Diabetes mellitus; Diabetic retinopathy; Meta-analysis; Periodontitis; Systematic review.

Publication types

Review