Background, Literature reference & rationale Diabetes is among the most common endocrine disorders and is characterized by hyperglycaemia, which

in association with elevated blood lipid levels (hyperlipidemia), leads to complications such as microangiopathy, retinopathy, nephropathy, microvascular disease and delayed wound healing (Kinane & Chestnutt, 1997). Type 2 diabetes (formerly classified as non-insulin dependent diabetes) is the more prevalent form of diabetes and affects nearly 90% of all diabetic patients (Mattout et al, 2006). Ethnicity plays a role in prevalence of diabetes. The prevalence of diabetes was higher in studies from India and Malta compared to Japan, China, and the rest of Europe (Nakagami et al, 2003). A Malaysian National Health Study of 20,041 individuals aged 30 and above in 1996 found that Indians had the highest blood glucose concentration followed by Chinese, Malays and other indigenous ethnic groups (Lim et al, 2000). A retrospective study in Malaysia involving 302 patients comprising Malays, Chinese and Indians who had undergone coronary artery bypass grafting (CABG) found that Indians had the highest prevalence of diabetes mellitus, hypertension and hyperlipidaemia (Chiam et al 2002). In a study in Singapore to determine the ethnic differences among Malay, Chinese and Indian patients with Type 2 diabetes, HbA1c levels were found to be highest among the Indians after controlling for age, duration of diabetes, BMI and treatment (Hong et al, 2004). Periodontitis is a multi-factorial disease with dental biofilm as its initiator (Kinane, 1999). Although microorganisms are the essential components of any model for progressive periodontitis, a susceptible host and/ or local environmental conditions increase susceptibility. In Western countries, it has been estimated that approximately 10-15% of the adult population will develop severe periodontitis (Brown et al 1990, Hugoson et al 1998, Albandar et al 1999). A recent national oral health study by the Ministry of Health Malaysia in 2000 (Oral Health Division, 2001) of 10,891 Malaysian adults (15-65+ years), using the CPITN (Community Periodontal Index of Treatment Needs) to assess the periodontal status, found that 90.2% of the dentate Malaysian subjects presented with periodontal conditions and only 5.5% of these subjects had deep pockets of 6 mm or more. The Malaysian population, made up of 3 major ethnic groups composed of Malays, Chinese and Indians, presents differences in the extent and severity of periodontal destruction possibly associated with different risk factors. Epidemiological investigations in Malaysia showed that ethnicity may be an important risk factor. Indian subjects have a higher prevalence of marked periodontal destruction as indicated by deep periodontal pocketing (Dental Division Ministry of Health 1977, Taiyeb Ali 2000). Diabetic status is an important risk factor in the pathogenesis of periodontal disease. It has been reported that subjects with diabetes have a greater prevalence and severity of periodontal disease compared with subjects without diabetes (Hugoson et al 1989, Emrich et al 1991, Grossi & Genco 1998, Taylor et al 1998). Loe (1993) has declared periodontal disease as the “sixth” complication of diabetes. This view has been supported by Rees (1994) who concluded that there is a direct relationship between diabetes mellitus and periodontal disease.

Although studies have shown that the Malaysian Indians have an increased prevalence of periodontal disease and also increased blood glucose concentration. .Severe periodontal disease increases the severity of diabetes mellitus and complicates its metabolic control. once transmitted into the systemic circulation. Gram-negative periodontopathogens. can amplify the magnitude of diabetic tissue injury through its pro-inflammatory cytokines. 1998). no known study has been conducted to determine if ethnicity of Malaysian patients with Type 2 diabetes and periodontitis have an effect on their glycaemic control as well as presence of subgingival periodontopathogens. and diabetic connective tissue degradation (Grossi & Genco. This periodontal infection can also induce a chronic state of insulin resistance which will contribute to the cycle of hyperglycemia.

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