Table 2
Case 4. Blood, urine, and GCF analyses from baseline to 6 months after therapy
GFC
Normal Range
Baseline
6 Months
IL-1β IL- 8 VEGF (pg/ml) (pg/ml) (pg/ml) — — —
176.43 513.45 9.96
1.75 24.58 undetectable
Albumin/
Creatinine
Ratio
(MG/G)
0 - 25
3995
2180.5
Random IL-1β
Urine (pg/ml)
Protein
(MG/DL
—
375.1
84.2
inflammation has emerged as a new risk factor for type 2 fective at reducing HbA1c levels but may also significantly diabetes. Within its context, this research could imply that reduce the development or progression of additional com-untreated periodontitis, which is a well known chronic in- plications such as kidney and CVD. A 34-year-old type 1 flammatory condition, might increase a person’s risk for diabetic female (Figure 5) was referred for possible par-the development of type 2 diabetes. Future studies should ticipation in a clinical study funded by the National Insti-be designed to address this issue. tute of Health (NIH), but she was ineligible to participate in the study because she was being treated for rheumatoid arthritis with prednisone.
Two studies have demonstrated that diabetic subjects Review of the patient’s medical history revealed she was with severe periodontitis are at greater risk for develop- diagnosed with type 1 diabetes at the age of 9, had laing nephropathy and CVD, which can both affect mortal- ser treatment to slow the progression of retinopathy 17 ity in this patient population. In an 11 year follow-up of years ago, and was diagnosed with periodontal disease subjects, diabetics with severe periodontitis had a greater 10 years ago, at the age of 28. The patient reported a prevalence of proteinuria indicative of nephropathy and a family history of periodontitis in both parents who had greater number of cardiovascular complications. 4 These type 2 diabetes. When asked about her dental history, oral-systemic connections in diabetic patients have been the only dental care she had received was a superficial confirmed most recently by Saremi and colleagues, 52 who prophylaxis. One year after the patient was diagnosed reported periodontal disease is strongly predictive of mor- with periodontal disease, she delivered her first daugh-tality from ischemic heart disease and diabetic nephropa- ter at 37 weeks. This first infant weighed 6 lbs, 1 ounce, thy in a population of Pima Indians with type 2 diabetes. and 5 years later a second daughter was prematurely In an 11 year follow-up, the age and sex-adjusted death delivered at 33 weeks weighing 3 lbs, 1 ounce. She had rates of type 2 diabetic patients increased with severity of not received any dental treatment for 10 years because periodontitis. 52 There is no doubt that optimal oral health she was under the impression that her periodontal dis-is essential to the medical management of the diabetic pa- ease had been addressed. In retrospect, one might ques-tient. tion the contribution of periodontal disease in addition
xi Humalog®, Eli Lilly, Indianapolis, IN
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