Periodontal disease as a potential risk factor for the development of diabetes in women with a prior history of gestational diabetes mellitus

Objective To examine if periodontal disease is associated with later development of impaired glucose metabolism in women with a recent history of gestational diabetes (GDM). Methods Women with (n=19) and without (n=20) a history of GDM were prospectively followed at 22months postpartum. All subjects underwent: a) a 75-gram oral glucose tolerance test (OGTT); and b) an oral examination for measuring periodontal disease. Insulin sensitivity and pancreatic -cell secretory capacity derived from fasting (HOMA-IR) and glucose-stimulated measures (SIOGTT and IGI/HOMA-IR) were determined. Periodontitis was defined as the presence of any site with a probing depth 4mm or a clinical attachment loss 4mm. Results Compared to women without a history of GDM, prior GDM women had significantly higher fasting glucose and insulin concentrations, increased insulin resistance and decreased -cell function. Although not statistically significant, prior GDM women had a higher prevalence of periodontal disease (42.1%) than women without a history of GDM (25.0%). Women with periodontal disease showed greater insulin resistance and lower -cell function. Women with both prior GDM and periodontal disease had the most impaired glucose metabolism; the insulin secretion-sensitivity index was significantly lower in women with both prior GDM and periodontal disease (208.20 +/- 2.60) than in women without prior GDM and periodontal disease (742.93 +/- 1.78) (P<0.05). Conclusions Women with prior GDM show reduced insulin sensitivity and inadequate -cell secretory function at 22months postpartum. Periodontal disease may contribute to their impaired glucose metabolism and future risk of developing diabetes.