Biomarkers for differentiating diabetic periodontitis from chronic periodontitis: a systematic review and meta-analysis.

2026-06-10
Frontiers in immunology 17
- Li Zhang
- Ru Li
- Shengnan Zhang
- Wenhui Kong
- Peipei Zhang
- Wenyue Zhang
- Jing Sun

PubMed: 42358973
DOI: 10.3389/fimmu.2026.1758079

Study Design

Type: Meta-Analysis
Sample size: n = 970
Population: 970 patients with DMCP and 905 with CP
Methods: Systematic search of PubMed, Embase, the Cochrane Library, and Web of Science from inception until October 2025; meta-analysis using random-effects model

Background

Diabetes-related periodontitis (DMCP) and chronic periodontitis (CP) are associated with significant differences in clinical presentation, pathogenesis, and treatment outcomes. However, reliable biomarkers for their early differentiation remain elusive. This study aims to identify discriminatory biomarkers between DMCP and CP to provide an evidence-based foundation for improved clinical management.

Methods

A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted from their inception until October 2025 for studies comparing biomarkers in DMCP and CP. Differences in biomarker levels between the two groups were expressed as Standardized Mean Differences (SMD) with 95% Confidence Intervals (CI). All meta-analyses were performed using a random-effects model.

Results

A total of 33 eligible studies were included, involving 970 patients with DMCP and 905 with CP. The meta-analysis revealed the following: (1) lipid profiles: the DMCP group demonstrated significantly higher levels of very low-density lipoprotein (VLDL) (SMD: 0.91; 95%CI: 0.43 to 1.39; P<0.001) compared to the CP group; (2) inflammatory factors: levels of interleukin-8 (IL-8) (SMD: 0.38, 95%CI: 0.06 to 0.70; P=0.021), and high-sensitivity C-reactive protein (hs-CRP) (SMD: 2.56; 95%CI: 0.31 to 4.82; P=0.026) were significantly elevated in the DMCP group; (3) oxidative stress-related markers: A significant decrease was observed in catalase (CAT) (SMD: -0.31; 95%CI: -0.58 to -0.05; P=0.021) and oxidized glutathione (GSSG) (SMD: -1.16; 95%CI: -1.76 to -0.55; P < 0.001) in the DMCP group. Conversely, levels of nitric oxide synthase (NOS) (SMD: 0.58; 95%CI: 0.11 to 1.05; P=.016) and 4-hydroxynonenal (4-HNE) (SMD: 7.05; 95%CI: 5.07 to 9.03; P < 0.001) were markedly higher; and (4) other biomarkers: the DMCP group exhibited significantly elevated levels of body mass index, eotaxin, glucose-dependent insulinotropic polypeptide, glucagon-like peptide-1, and plasminogen activator inhibitor-1, alongside significantly reduced levels of C-peptide and 25-hydroxyvitamin D.

Conclusions

Significant differences in biomarkers related to lipid metabolism, inflammatory response, and oxidative stress were observed between patients with DMCP and CP. Key indicators demonstrating relatively robust differences include VLDL, 4-HNE, CAT, GSSG, NOS, IL-8, hs-CRP, and C-peptide.

Systematic review registration

https://inplasy.com/inplasy-2025-11-0067/, identifier INPLASY2025110067.