Neutrophil Function and Treatment Response in Diabetics with Periodontal Disease

Objective: Periodontitis is a complication of diabetes mellitus (DM).  Neutrophils (PMN) are primed in patients with DM resulting in excessive production of reactive oxygen species. Reciprocally, periodontitis presents an inflammatory state that complicates the control of DM.  We hypothesized that neutrophil function can be used as a biomarker of the disease severity in diabetics. The aim of this study was to analyze the superoxide production by the PMN as a marker of disease severity and a predictor of treatment outcome in people with diabetes and periodontitis.

Method: Informed consent was obtained from patients (n=16; 12 males, 4 females; age range: 35-71) participating in the study. Peripheral blood PMN were isolated by density gradient centrifugation and superoxide was measured by cytochrome C reduction.  Diabetic control was monitored by HbA1c; periodontal treatment consisted of oral hygiene instruction, scaling and root planing plus systemic antibiotics, surgical intervention, and maintenance every 2 months after the active therapy was completed and clinical measurements, diabetic control and neutrophil superoxide generation was recorded at each maintenance visit out to 12 months.

Result: Blood glucose and HbA1c showed a significant decrease after therapy (Baseline: 8.9±1.7 vs 4 months: 6.9±0.7, 12 months: 7.5±1.3; p<0.05).  Likewise, periodontal parameters were significantly improved in response to treatment (Clinical attachment level: Baseline: 3.8±2.2 vs 4 months: 2.3±2.4, 12 months: 2.7±2.1; p<0.05). Diabetic PMN were primed at baseline and produced significantly more superoxide in response to fMLP (2.5-fold increase over healthy PMN; p<0.05).  Superoxide measurements correlated with the periodontal and diabetic parameter improvements.

Conclusion: PMN superoxide generation can be used as a biomarker for the severity, as well as the control of diabetes.  Change in glycemic parameters, periodontal parameters and superoxide anion production in response to treatment demonstrate that inflammation and treatment outcome can be monitored by PMN function.