Diabetes, Periodontal Disease, and Quality of Life in Adults with Cystic Fibrosis

Fellow: Alaa Alkhateeb, MS
Oral Healther

Mentor: Donald Chi, DDS, PhD
Associate Professor, Oral Health

There are few studies on the oral health of individuals with cystic fibrosis (CF), even though poor oral health is a potential contributor to worsening chronic health conditions. Cystic fibrosis-related diabetes (CFRD) is a common comorbidity in individuals with CF. By adulthood, 40% to 50% of individuals with CF are diagnosed with CFRD and another 30% have glucose impairment (pre-diabetes). In CF, diabetes is associated with worse pulmonary function, poorer nutritional status, pancreatic insufficiency, and early death. Periodontal disease (also called gum disease) is a common complication of diabetes. The prevalence of periodontal disease is significantly higher in US adults with diabetes than those without diabetes. Several proposed mechanisms including host defense and bacterial factors explain the link between diabetes and periodontal disease.

The strong association between diabetes and periodontal disease is well described in the literature but has not been examined among adults with CF. Our CFF-funded pilot study of the oral health of individuals with CF ages 11 to 20 years led by Dr. Donald Chi showed that individuals with CFRD had poorer oral hygiene, more tooth surfaces with dental plaque, and deeper periodontal pockets compared to individuals with CF with no diabetes diagnosis. All of these are markers of periodontal disease. However, there are two critical limitations with our pilot data, both of which are addressed in the proposed study. First is the small number of subjects with CFRD, which was expected because the pilot study focused on children and teens with CF and the prevalence of diabetes in this age group is low. Second, we did not collect data on glycemic levels. Glucose impairment is prevalent in individuals with CF without diabetes diagnosis. As a result, it is highly likely that a high proportion of our non-CFRD group did not have normal glycemic levels which could impact their periodontal health and led to underestimating the risk of periodontal disease associated with diabetes. Our proposed study will address these limitations by studying periodontal disease in an adult population with CF; recruiting a sufficient number of adults with CFRD; and ascertaining a CF comparison group with normal glycemic level. There are 3 specific aims:

Aim 1. Identify risk factors for periodontal disease in adults with CF.

1.1 Hypothesis. Various medical, socio-demographic, and behavioral factors are associated with worse periodontal health in adults with CF.

Aim 2. Examine the association between diabetes and periodontal disease and the impact of this association on the quality of life for adults with CF.

2.1 Hypothesis. Diabetes is associated with worse periodontal health in adults with CF.

2.2 Hypothesis. Periodontal disease is associated with lower quality of life in adults with CF.

Aim 3. Examine how the associations in Aim 2 differ by CF status.

3.1 Hypothesis. The associations between diabetes, periodontal disease, and oral health related quality of life in adults with CF are different than in non-CF controls.