Associations Between Glycemic Control, Self-Reported Gingival Bleeding and Lifestyle Factors in Hospitalized Diabetic Patients

Abstract

Background/Objectives: Diabetes mellitus is associated with significant health complications, including challenges in periodontal health. Gingival inflammation is especially common among diabetic patients and can significantly impact overall diabetes management. This study aims to investigate the correlation between glycosylated hemoglobin (HbA1c) levels, an established marker of glycemic control, and gingival inflammation using the Quantitative Gingival Bleeding Index (QGBI) among hospitalized diabetic patients, thereby placing the question within a broader clinical context. Methods: The study enrolled 671 hospitalized patients with diabetes complications at "Mother Theresa University Hospital" in Tirana, AL, USA. Glycemic control was assessed through glycosylated hemoglobin (HbA1c) levels, and gingival health was evaluated using the Quantitative Gingival Bleeding Index (QGBI). Behavioral variables were also documented, including smoking habits and routine oral care practices. Spearman's correlation coefficient (r_s) was applied to determine the relationship between HbA1c levels and QGBI scores. Results: Our findings revealed a strong positive correlation between glycemic control (HbA1c) and gingival inflammation (QGBI) among the participants (Spearman's coefficient r_s = 0.868, p < 0.001). Additionally, significant positive associations were observed between behavioral factors, such as smoking habits and regular oral care practices, further underscoring their role in periodontal health in diabetic patients. Conclusions: The study highlights a significant positive relationship between poor glycemic control and increased gingival inflammation, emphasizing the importance of periodontal health in the comprehensive management of diabetes mellitus. Our results support integrating periodontal evaluation and management into standard diabetes care, which could improve patient outcomes and overall well-being.

Keywords: HbA1c levels; Quantitative Gingival Bleeding Index; dental care; diabetes mellitus; gingival health; hospitalized patients; oral health.

Figure 1

This illustration depicts the multisystemic impact of periodontal inflammation in individuals with diabetes mellitus. A clinical representation of gingival bleeding and inflammation at the center highlights active periodontal disease. Around the central illustration are depicted several complications associated with diabetes, along with key contributing factors. Cardiovascular and cerebrovascular implications are shown, reflecting the increased risk of heart disease and stroke associated with chronic inflammation and poor glycemic control. An unhealed wound reflects the reduced healing capacity often seen in diabetes. Nephropathy and retinopathy represent microvascular damage affecting the kidneys and eyes, respectively. A blood draw highlights the importance of monitoring glycemic control through HbA1c levels. Behavioral risk factors such as smoking and alcohol use, a high-lipid diet, and aging are identified as contributors to disease progression. A world map in the background underscores the global relevance of these interrelated health challenges and the potential of integrating oral health assessments into comprehensive diabetes care. Illustration by Nensi Kallfani.

Figure 2

Box plot showing the relationship between HbA1c levels and QGBI scores, highlighting the trend of increasing glycemic levels with greater gingival bleeding severity.