Plasma Levels of Tumor Necrosis Factor-alpha in Patients with Chronic Periodontitis and Type 2 Diabetes

Objectives: Studies suggest that elevated circulating tumor necrosis factor-alpha (TNF-alpha) may contribute to insulin resistance in patients with type 2 diabetes. The source of plasma TNF-alpha has been thought to be adipocytes associated with obesity, however inflammation and infection have been shown to increase TNF-alpha production as well. Methods: We studied 45 patients with type 2 diabetes and chronic periodontitis. We evaluated the relationship between plasma TNF-alpha levels and clinical measures of periodontal disease, gingival crevicular fluid (GCF) interleukin-1ß(IL-1ß), serum glucose, and glycated hemoglobin (HbA1c) using a Spearman Rank correlation. TNF-alpha and IL-1ß levels were measured using a high sensitivity enzyme-linked immunosorbent assay. Results: TNF-alpha showed a significant positive correlation with clinical attachment loss (r = 0.395, P =.009) and GCF IL-1ß(r = 0.330, P =.035), but not serum glucose(r = 0.077, P =.62), HbA1c(r = 0.103, P =.50), or body mass index(r = -0.291, P =.26). Conclusion: These results indicate that chronic periodontitis may contribute to elevated circulating TNF-alpha levels and hence play a role in insulin resistance associated with type 2 diabetes. Supported by Columbia University Office of Clinical Trials Pilot Award (SE), and K23 DE 00449(SE).