“The Perio-Diabetes Symposium”: Consensus Report of the Indian Society of Periodontology and Research Society for the Study of Diabetes in India - A joint event on Periodontitis and Diabetes

PREAMBLE

Diabetes and periodontitis are chronic inflammatory conditions with associated shared risk factors. There exists a strong bidirectional relationship between the two disease giants.[1] This means diabetics have a higher risk of periodontal diseases and severe periodontitis leads to poor glycemic control.[2] Both the diseases are common and have high prevalence rate and become clinically complex with ageing. The periodontal disease is present in as many as 80% of people aged above 35 years and diabetes affects around 8-12% of urban Indian population. In any district of India as many as 35-40% of people can be classified as suffering from metabolic syndrome or pre-diabetes.

The complexities of treatment, success in management and prognostic implications get seriously compromised when periodontitis and diabetes coexist. One can easily imagine and calculate the health burden, including economic drain and quality of life issues, the country and society must already be facing with 72 million diabetics in India. It is also well documented that awareness of this bidirectional relationship between periodontal disease and diabetes is neither included in the medical education curriculum in India, nor any formal and serious attention has been imparted in clinical world and its academic activities.

Considering the current scenario in Indian perspective, a joint conclave was organized by Research Society for the Study of Diabetes in India (RSSDI) - Delhi Chapter and Indian Society of Periodontology (ISP) – Study Group Delhi-NCR on 8^th of September 2019 at Hotel Eros, Nehru Place, New Delhi. It was attended by more than 150 delegates all over the country consisting of faculties from various dental colleges, postgraduate students, endocrinologists, senior medical consultants and oral and general healthcare providers [Figure 1].

Figure 1.

The Perio -Diabetes symposium delegates

This full day symposium was actively supported by governing council members of both the societies, who also participated as resource faculty for the entire scientific program. The lectures were well attended and appreciated by delegates and faculty members from both the societies and the day culminated with a panel discussion session as represented by the panelists from both the specialties.

THE 7 CONCLUSIVE POINTS OF AGREEMENT

1. Pre-diabetics and diabetics have higher chances of developing periodontal diseases and those with Periodontitis have a higher chance of developing pre-diabetes and type-2 diabetes

2. The causality between the gingival microbiome and diabetes, though remains unproven but periodontal microbiome does get affected/altered in the presence of hyperglycemia

3. There is enough validation for diabetes and its complications getting exacerbated in the presence of periodontitis and of the fact that certain biological mechanisms do mediate the negative effects of periodontitis on the control of diabetes. Newer biologic evidence also emphasizes the role of lipid imbalance in the exacerbation of both the diseases through the role of cytokines[3]

4. The chronic inflammatory state which contributes to pathophysiology of diabetes and its prognosis, itself gets seriously exacerbated in the presence of periodontitis

5. Improving the diabetic control results in improved periodontal health and that in turn helps in better control of diabetes and its complications

6. Clinicians of the respective specialties fully acknowledge and understand the gravity of diabetes and its associated risk with periodontitis and vice versa. The also agreed that the lacuna of understanding and practice about the two disease association needs to be addressed

7. A set of practice guidelines must be developed and incorporated as formal publications by respective societies.

FUTURE DIRECTIONS FOR CLINICAL PRACTICE AND RESEARCH

The experts and panel of both the societies in the symposium consented upon the following steps to be undertaken as collaborative efforts to fulfill the unmet needs in the areas as discussed and agreed:

• 1)There should be more such scientific interactions planned by both the participating societies. Small round table meets and CME sessions to create more awareness on the issues of bidirectional relationship of two diseases
• 2)Guest speakers and faculty members must be included in conferences/symposia in the form of at least one session or lecture covering the relationship of diabetes and periodontal disease
• 3)Public awareness modules must also be developed
• 4)Data collection from across the practices in both specialties must be seriously initiated in order to validate the gravity of the health burden posed by periodontal disease and diabetes, so that socio-political atmosphere can be generated getting enough attention from policy makers and health care planners. That must include third party payers and insurance providers, as and where relevant
• 5)Incorporation of dental/oral health screening in diabetic patients as a part of regular visits and vice versa on screening the diabetic history in patients suffering from periodontitis
• 6)MCI and DCI (governing bodies for medical and dental education in India) should introduce chapters in the undergraduate curriculums about the importance of diabetes and periodontal/oral health. This would perhaps sensitize this vital continuum at the undergraduate teaching
• 7)Basic oral health information and patient counselling/education tools must be a part of a diabetic clinic
• 8)Cross referals amongst the diabetologists and periodontists/dentist for early detection and diagnosis of diabetes and periodontitis
• 9)At the society levels collaborative clinical research studies should be undertaken.

Anil M¹, Rajeev Chawla², Nitin Dani³, Nymphea Pandit⁴, Vinod Kumar⁵, Meena Chhabra⁶, Manish Khatri⁷, Vikram Blaggana⁸, Rajesh Marya⁹, Shalini Jaggi¹⁰

President ISP1, President RSSDI2, Immediate Past President ISP3, President Elect ISP4, Patron RSSDI5, Chairman Elect RSSDI Delhi Chapter6, Treasurer ISP Study Group Delhi NCR7, Convener ISP Study Group Delhi NCR8, Advisor RSSDI Delhi Chapter9, Joint Secretary RSSDI Delhi Chapter10.