Diabetes mellitus (DM) is a chronic metabolic disorder that affects multiple biochemical and cellular processes in the body, resulting in diminished immunity and heightened susceptibility to infections.1 Worldwide, nearly 7 million new cases of DM are reported annually, and it is estimated that by 2030 the number of individuals living with diabetes will reach 366 million. Among its systemic complications, DM has been consistently recognized as an important risk factor for periodontal disease2,3. Periodontitis is a chronic, microbial-associated, host-mediated inflammatory condition characterized by progressive destruction of periodontal ligament fibers, connective tissue, and alveolar bone, ultimately leading to attachment loss and tooth mobility. The relationship between DM and periodontitis is complex and bidirectional.4 Diabetes predisposes individuals to periodontal destruction through impaired neutrophil function, altered cytokine profiles, and compromised wound healing, which collectively create an environment that favors bacterial persistence within periodontal pockets. Conversely, periodontal inflammation itself can adversely influence glycaemic control.5 Gram-negative bacterial infections associated with periodontitis increase systemic inflammatory mediators, reduce insulin-mediated glucose uptake by skeletal muscle, and contribute to insulin resistance, thereby worsening glycemic regulation. Evidence shows that effective periodontal therapy can lower glycated hemoglobin (HbA1c) levels and improve metabolic control.6 Globally, numerous studies have assessed the prevalence and risk factors for periodontitis among diabetic patients. Increasing age has been significantly associated with higher prevalence of periodontal disease among individuals with diabetes, reflecting cumulative tissue damage and long-term exposure to hyperglycemia7. Sex differences have also been explored, with some studies reporting higher prevalence among males. Lifestyle factors such as smoking further exacerbate periodontal breakdown and have been strongly linked to periodontitis in diabetic populations. Elevated HbA1c levels, indicating poor glycaemic control, have also been identified as an important predictor of periodontal disease severity, highlighting the interplay between metabolic and oral health8. Periodontitis negatively impacts quality of life by causing gingival bleeding, recurrent infections, compromised mastication, aesthetic concerns, and ultimately tooth loss, affecting nutrition, comfort, confidence, and social interactions9. Growing evidence supports the two-way relationship between diabetes and periodontitis, emphasizing the need for integrated management strategies to improve both oral and systemic health outcomes. AIM To study the prevalence of periodontal disease among diabetic and non diabetic patients.

The present study was designed as a cross-sectional observational study and was conducted in the ESIC MCH Alwar, and Data collection was carried out over a one-year period from December 2024- June 2025. The study population consisted of individuals attending the outpatient periodontal clinic during the study period, and participants were categorized into two groups: diabetic patients and non-diabetic individuals serving as the control group. A total of 180 participants were selected using convenient sampling methods. Individuals aged 18–70 years with at least 20 natural teeth were eligible for inclusion, and diabetic participants were required to have a confirmed diagnosis of Type 2 diabetes along with a documented HbA1c report within the previous three months. Non-diabetic individuals were included if they had normal fasting blood glucose and HbA1c levels. Written informed consent was obtained from all participants prior to enrollment. Exclusion criteria included patients with Type 1 diabetes or gestational diabetes, those who had received periodontal therapy within the last six months, individuals on antibiotics, anti-inflammatory drugs, or medications known to influence periodontal status, as well as smokers, pregnant women, lactating mothers, and patients with systemic diseases or conditions that could interfere with periodontal assessment.

Table 1: Socio-Demographic Characteristics of Study Participants (N = 180) Age Group Diabetic (n=90) Non-Diabetic (n=90) 18–30 years 11 8 31–45 years 47 44 46–60 years 23 28 >60 years 9 10 The age distribution of the study participants showed that the majority belonged to the 31–45-year age group in both diabetics (47 participants) and non-diabetics (44 participants), indicating that most cases occurred in middle-aged adults. Participants aged 46–60 years formed the next largest group, with 23 diabetics and 28 non-diabetics. Table 2: Clinical Characteristics of Diabetic Participants (n = 90) Variable Number Percentage Duration of Diabetes < 5 years 15 16% 5–10 years 44 48% >10 years 31 36% HbA1c Levels Controlled (<7%) 41 45% Moderately Controlled (7–8.5%) 29 32% Poor Control (>8.5%) 20 23% The duration of diabetes among participants showed that nearly half (48%) had the condition for 5–10 years, followed by 36% who had diabetes for more than 10 years, while only 16% reported a duration of less than 5 years. In terms of glycemic control, 45% of individuals had well-controlled HbA1c levels below 7%, whereas 32% demonstrated moderately controlled levels between 7–8.5%. Poor glycemic control (>8.5%) was seen in 23% of participants, indicating that almost one-fourth were at increased risk for diabetes-related complications. Table 3: Oral Hygiene & Lifestyle Characteristics (N = 180) Variable Diabetic (n=90) Non-Diabetic (n=90) Brushing once daily 59 54 Brushing twice daily 31 36 Interdental aid use 29 27 Mouthwash use 28 30 Dental visit in last 1 year 12 10 The oral hygiene habits of the study participants showed that most individuals brushed once daily, with 59 diabetics and 54 non-diabetics, while brushing twice daily was reported by 31 diabetics and 36 non-diabetics. Interdental aid use, mouthwash use, and dental visits in the past year were relatively low and comparable between both groups, indicating generally similar oral hygiene practices. Table 4: Prevalence of Periodontal Disease Among Diabetic vs. Non-Diabetic Patients Severity Category Diabetic (n=90) Non-Diabetic (n=90) No Periodontitis 16 59 Mild 27 16 Moderate 39 12 Severe 8 3 The prevalence of periodontal disease differed markedly between the groups, with only 16 diabetics showing no periodontitis compared to 59 non-diabetics. Diabetics had higher rates of mild (27), moderate (39), and severe (8) periodontitis, whereas non-diabetics showed lower rates of mild (16), moderate (12), and severe (3) disease, indicating a clear association between diabetes and increased periodontal severity. Table 5: Association Between HbA1c Levels and Periodontal Disease Severity (Diabetic Group, n=90) HbA1c Category Mild Periodontitis (27) Moderate Periodontitis (39) Severe Periodontitis (8) Controlled(<7%) 13 12 0 7–8.5% 8 18 3 >8.5% 6 9 5 The distribution of periodontal disease severity according to HbA1c levels showed that participants with controlled HbA1c (<7%) mostly had mild (13) or moderate (12) periodontitis, with none exhibiting severe disease. Those with higher HbA1c levels (7–8.5% and >8.5%) had progressively more moderate and severe periodontitis, indicating a strong association between poor glycemic control and increased periodontal severity. Table 6: Association Between Duration of Diabetes and Periodontal Disease Severity (n = 90) Duration of Diabetes Mild Periodontitis (27) Moderate Periodontitis (39) Severe Periodontitis (8) < 5 years 6 7 1 5–10 years 12 15 2 >10 years 9 17 5 The distribution of periodontal disease severity according to the duration of diabetes showed that participants with longer disease duration had higher severity, with those having diabetes for >10 years exhibiting 9 mild, 17 moderate, and 5 severe cases. In contrast, participants with <5 years of diabetes had fewer cases of moderate (7) and severe (1) periodontitis, while those with 5–10 years had intermediate severity, indicating a clear relationship between longer diabetes duration and increased periodontal destruction.

The age-wise distribution of participants revealed that the highest proportion belonged to the 31–45-year age group, with 47 diabetic and 44 non-diabetic individuals, indicating that middle-aged adults formed the core study population. The 46–60-year group was the next most common, comprising 23 diabetics and 28 non-diabetics, showing a substantial representation of older adults as well. Younger participants aged 18–30 years were fewer, with only 11 diabetics and 8 non-diabetics included. Also, the >60-year age group had the smallest representation, consisting of 9 diabetics and 10 non-diabetics. Similarly, Reddy et al10 Among diabetics; 28.8% (144) were in the age group of 35–44, 37.6% (188) were in the group of 45–54, and 9.8% (49) were in the age group of 65–74. Among nondiabetics; 33% (165) were in the 35–44 age group, 42.6% (213) were in the age group of 45–54, and 8.2% (41) were in the group of 65–74 . The distribution of diabetes duration revealed that the largest group of participants, 48%, had diabetes for 5–10 years, highlighting a substantial population with long-standing disease. This was followed by 36% who had been diabetic for more than 10 years, indicating a significant chronic burden, while only 16% had a duration of less than 5 years. Evaluation of glycemic status showed that 45% of participants had controlled HbA1c levels below 7%, reflecting relatively good metabolic regulation in nearly half of the group. Another 32% had moderately controlled HbA1c levels between 7–8.5%, representing those with borderline glycemic management. Meanwhile, 23% exhibited poor control with HbA1c levels above 8.5%, identifying a notable proportion at higher risk for complications and more severe periodontal involvement. The assessment of oral hygiene habits among participants revealed that the majority of both diabetic and non-diabetic individuals brushed once daily, with 59 diabetics and 54 non-diabetics, while brushing twice daily was less common, reported by 31 diabetics and 36 non-diabetics. Use of interdental aids was limited, with 29 diabetics and 27 non-diabetics incorporating them into their routine, suggesting suboptimal oral hygiene practices. Similarly, mouthwash use was reported by 28 diabetics and 30 non-diabetics, indicating moderate adoption of supplementary oral care measures. Dental visits in the past year were infrequent, with only 12 diabetics and 10 non-diabetics attending, reflecting low professional dental engagement. Overall, oral hygiene behaviors were comparable between the two groups, with most participants relying primarily on basic tooth brushing.Also, Ojo KO et al11 majority of the diabetic patients 90 (81.8%) and non-diabetic respondents 92 (83.6%) used toothbrush and paste in cleaning their teeth. Nearly three quarters of diabetic group brushed once daily 80 (72.7%) compared to about half 59 (53.6%) of the non-diabetes group, and majority used toothpick in cleaning the space between their teeth 74 (67.3%) among diabetes group while 73 (66.4%) among non-diabetes group did same. The assessment of periodontal disease severity revealed a clear difference between diabetic and non-diabetic participants. Among diabetics, only 16 individuals had no periodontitis, whereas a majority of non-diabetics, 59 participants, were free of the disease. Mild periodontitis was observed in 27 diabetics compared to 16 non-diabetics, while moderate periodontitis affected 39 diabetics versus 12 non-diabetics. Severe periodontitis was relatively uncommon but still higher in diabetics, with 8 cases compared to 3 in the non-diabetic group. Overall, these findings indicate that diabetic individuals are more prone to periodontal disease across all severity levels. This highlights the significant impact of diabetes on periodontal health and the need for targeted preventive and therapeutic interventions.Similarly, de Miguel-Infante A et al12 The prevalence of periodontal disease was higher among those suffering from diabetes than their non-diabetes controls (23.8% vs 19.5%; P < 0.001). Adjusted OR of periodontal disease for subjects with diabetes was 1.22 (95% CI; 1.03-1.45). The analysis of periodontal disease severity according to HbA1c levels revealed a clear relationship between glycemic control and periodontal health. Among participants with controlled HbA1c levels (<7%), most had mild (13) or moderate (12) periodontitis, and none exhibited severe disease, suggesting effective metabolic control may protect against severe periodontal destruction. In those with moderately controlled HbA1c (7–8.5%), 8 individuals had mild, 18 had moderate, and 3 had severe periodontitis, indicating an increase in disease severity with rising blood glucose levels. Participants with poorly controlled HbA1c (>8.5%) showed the highest severity, with 6 mild, 9 moderate, and 5 severe cases, highlighting the strong impact of hyperglycemia on periodontal tissue destruction. Poor glycemic regulation was closely associated with higher prevalence and severity of periodontal disease among diabetic patients. The analysis of periodontal disease severity according to the duration of diabetes demonstrated a clear trend of increasing severity with longer disease duration. Among participants with less than 5 years of diabetes, 6 had mild, 7 had moderate, and only 1 had severe periodontitis, indicating relatively limited periodontal involvement in newly diagnosed patients. Those with 5–10 years of diabetes showed an intermediate pattern, with 12 mild, 15 moderate, and 2 severe cases, reflecting progressive tissue destruction over time. Participants with more than 10 years of diabetes exhibited the highest severity, with 9 mild, 17 moderate, and 5 severe cases, highlighting the cumulative effect of prolonged hyperglycemia on periodontal tissues. Data indicate that longer exposure to diabetes significantly increases the risk and severity of periodontitis. Khader Y et al13 The severity of periodontal disease was significantly higher in patients with diabetes > 5 years than those with duration ≤ 5 years.

The present study demonstrates a significantly higher prevalence and severity of periodontal disease among diabetic individuals compared to non-diabetic controls. Middle-aged and older adults formed the core study population, and longer duration of diabetes was strongly associated with increased periodontal destruction. Poor glycemic control, reflected by elevated HbA1c levels, was closely linked to more severe periodontitis, highlighting the impact of hyperglycemia on periodontal tissues. Oral hygiene practices were generally suboptimal but comparable between diabetic and non-diabetic participants, suggesting that diabetes itself is a major risk factor beyond oral hygiene behavior. These findings confirm the bidirectional relationship between diabetes and periodontitis, where diabetes exacerbates periodontal disease and periodontal inflammation may adversely affect glycemic control. Early screening, improved glycemic management, and targeted periodontal care are essential to reduce periodontal morbidity and improve overall health outcomes in diabetic patients.

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