Analysis of PISA, PESA and HbA1C Levels in Young Pre-Diabetics

Method: To begin to characterize the periodontal inflammatory burden in a cohort of pre-diabetics at the Georgia Prevention Institute, complete periodontal examination was performed on 10 pre-diabetics (HbA1C > 5.7%) and 16 non-diabetics (HbA1C < 5.7%).    Probing depths (PD) and bleeding on probing (BOP) were recorded on 6 sites per tooth. The mean PD around each tooth was used to calculate the periodontal epithelial surface area (PESA) in mm² (Hujoel et. al. 2001) and this number was multiplied by the proportion of sites with BOP to calculate the periodontal inflamed surface area (PISA) in mm²  (Nesse et al 2008). The sum of all PISAs gives the total inflamed surface area in mm²for each patient. 

Result: The mean PESA and PISA (+ S.E.M). in the young pre-diabetic cohort were 1581.5 ± 70 and 411.9 + 86 respectively, versus 1537.6+ 64 and 504.4 +79 in the non-diabetic controls. There was a trend, though not significant, for increased PESA in pre-diabetics.  Sample size estimate reveals that n=42 in each group would be necessary to detect a significant difference (a = .05) in PESA at 80% power.

Conclusion: In this young cohort, pre-diabetes appears to show a trend for increasing periodontal epithelial surface area, but not in overall inflammatory burden, as previously reported in older patients (Nibali et al 2007). As this cohort gets older, we expect to see more significant changes in the inflammatory burden as periodontal disease worsens in pre-diabetics compared to non-diabetics.