Combating Diabetes and Heart Disease with Oral Care
Pioneering work led by Professor D’Aiuto(1, 2) at UCL/UCLH discovered the underlying links between chronic gum disease (periodontitis), type 2 diabetes and cardiovascular disease (CVD). His team also investigated clinical interventions for periodontitis that improve cardiovascular and diabetes outcomes. Their ground-breaking work informed NHS care pathways and international treatment guidelines.
Diabetes and CVD are leading causes of mortality and disability worldwide. CVD causes the death of 17.9 million people each year (31% of deaths) and the prevalence of diabetes has more than doubled since 1980 (180-470 million sufferers).
Studies of patterns of disease in the population have long suggested a relationship between CVD, diabetes and periodontitis as those with periodonititis are more likely to suffer from CVD or diabetes and vice versa. But the reasons for this relationship remained unclear, hampering development of clinical interventions to reduce the risk and severity of both conditions.
In collaboration with the UCLH-BRC Cardiovascular Theme, D’Aiuto and colleagues led research identifying periodontitis as a possible trigger of systemic body inflammation, which in turn increases the risk of CVD and diabetes. He then began to develop treatments to address this. Informed by an innovative PPI pilot project funded by the UCL Centre for Co-Production, D’Aiuto completed early clinical trials demonstrating that treatment of periodonititis reduces inflammation, and a larger follow-up trial showed the benefits of treatment for periodontitis for several risk factors for CVD, including blood pressure, circulation problems and signs of inflammation. He also led an initial study and a later clinical trial demonstrating a significant reduction in blood glucose level in people with type 2 diabetes following treatment of periodonititis(3).
D’Aiuto’s findings informed the Office of the Chief Dental Officer, making Oral Health promotion in diabetes a UK National Strategic Priority. The NHS Commissioning Standard “Dental Care for People with Diabetes” (2019) recommended integrated care pathways for patients with diabetes and periodontitis for the first time, with economic evaluations projecting a saving to the NHS of £124M due to less frequent GP visits and reduced drug costs. Further clinical pathway recommendations for patients with periodontitis and cardiovascular diseases were published by the Royal College of Surgeons, Public Health England and the World Heart Foundation.
References:
- D'Aiuto F et al. Am Heart J, 2006
- Tonetti MS et al. N Engl J Med, 2007
- D’Aiuto F et al. Lancet Diabetes Endocrinol, 2018
