Non-Cochrane · aetiology · PM42358973

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

Zhang Li, Li Ru, Zhang Shengnan, et al. · Frontiers in immunology · 2026 · PubMed · doi:10.3389/fimmu.2026.1758079

Findings

Population Patients with periodontitis; diabetes-related periodontitis (DMCP) group versus chronic periodontitis without diabetes (CP) group

67 findings

Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Visfatin levelSMD 0.22 [-1.00, 1.43]
GRADE not reported
3 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-10 levelSMD 0.04 [-0.58, 0.67]
GRADE not reported
5 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)LDL cholesterol levelSMD 0.55 [-0.46, 1.57]
GRADE not reported
5 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-23 levelSMD 0.19 [-0.17, 0.54]
GRADE not reported
3 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)HDL cholesterol levelSMD -0.19 [-0.90, 0.51]
GRADE not reported
5 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Reactive oxygen metabolites (ROM) levelSMD 1.28 [0.60, 1.97]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)RAGE levelSMD 0.01 [-0.50, 0.51]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Granulocyte colony-stimulating factor (G-CSF) levelSMD 0.37 [-0.22, 0.96]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-21 levelSMD 0.12 [-0.27, 0.50]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Total antioxidant capacity (TAOC) level
Trim-and-fill adjusted for publication bias
Conclusion unchanged (not significant) after trim-and-fill; Begg P=0.035, Egger P=0.105.
GRADE not reported
Studies not reported
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-7 levelSMD 0.12 [-0.42, 0.66]
GRADE not reported
2 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-8 levelSMD 0.38 [0.06, 0.70]
GRADE not reported
2 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)RORC2 levelSMD -0.37 [-0.88, 0.15]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Monocyte chemoattractant protein-1 (MCP-1) levelSMD -0.29 [-0.88, 0.29]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Transforming growth factor beta levelSMD 0.27 [-0.06, 0.61]
GRADE not reported
2 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Plasminogen activator inhibitor-1 (PAI-1) levelSMD 3.80 [3.07, 4.53]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-4 level
Trim-and-fill adjusted for publication bias
Conclusion unchanged (not significant) after trim-and-fill; Egger P=0.003.
GRADE not reported
Studies not reported
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-4 levelSMD -0.62 [-1.37, 0.13]
GRADE not reported
5 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Tumor necrosis factor alpha level
Trim-and-fill adjusted for publication bias
No longer significant after trim-and-fill; Egger P=0.004, Begg P=0.251.
GRADE not reported
Studies not reported
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Oxidized glutathione (GSSG) levelSMD -1.16 [-1.76, -0.55]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Body mass index (BMI) level
Trim-and-fill adjusted for publication bias
Remained significant after trim-and-fill; publication bias indicated.
GRADE not reported
Studies not reported
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Glucagon-like peptide-1 (GLP-1) levelSMD 3.66 [2.94, 4.37]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interferon gamma levelSMD 0.28 [-0.28, 0.83]
GRADE not reported
4 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)RANKL levelSMD 0.55 [-0.18, 1.27]
GRADE not reported
2 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-1 beta levelSMD 0.29 [-0.45, 1.03]
GRADE not reported
2 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)8-isoprostane levelSMD -0.25 [-0.75, 0.26]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Nitric oxide synthase (NOS) levelSMD 0.58 [0.11, 1.05]
GRADE not reported
2 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Total cholesterol levelSMD 0.65 [-0.35, 1.65]
GRADE not reported
5 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Catalase (CAT) levelSMD -0.31 [-0.58, -0.05]
GRADE not reported
4 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Leptin levelSMD 2.33 [-1.80, 6.46]
GRADE not reported
3 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Glutathione reductase (GR) levelSMD 0.33 [-0.18, 0.84]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)VLDL cholesterol levelSMD 0.91 [0.43, 1.39]
GRADE not reported
2 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-13 levelSMD 3.15 [-3.02, 9.33]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Tissue inhibitor of metalloproteinase-3 (TIMP-3) levelSMD 0.87 [0.14, 1.60]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Eotaxin levelSMD 2.26 [1.51, 3.01]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Macrophage inflammatory protein-1 alpha (MIP-1a) levelSMD 0.97 [-0.10, 2.03]
GRADE not reported
2 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Ghrelin levelSMD 0.03 [-0.42, 0.47]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Granulocyte-macrophage colony-stimulating factor (GM-CSF) levelSMD 0.60 [-0.72, 1.93]
GRADE not reported
2 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Superoxide dismutase (SOD) levelSMD 0.90 [-0.26, 2.07]
GRADE not reported
5 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Glucose-dependent insulinotropic polypeptide (GIP) levelSMD 6.50 [5.41, 7.59]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-6 level
Trim-and-fill adjusted for publication bias
No significant difference after trim-and-fill; Egger P=0.005, Begg P=0.019.
GRADE not reported
Studies not reported
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Oxidative stress index (OSI) levelSMD 0.22 [-0.40, 0.84]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)25-hydroxyvitamin D [25(OH)D] levelSMD -0.57 [-0.98, -0.15]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Total antioxidant capacity (TAOC) levelSMD -0.50 [-1.30, 0.30]
GRADE not reported
7 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Uric acid levelSMD 0.35 [-0.07, 0.77]
GRADE not reported
2 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Tumor necrosis factor alpha levelSMD 0.88 [0.10, 1.66]
GRADE not reported
6 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Toll-like receptor 2 levelSMD 0.04 [-0.47, 0.54]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)High-sensitivity C-reactive protein levelSMD 2.56 [0.31, 4.82]
GRADE not reported
2 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Osteoprotegerin levelSMD 0.19 [-0.48, 0.86]
GRADE not reported
2 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-12 levelSMD 0.74 [-1.02, 2.51]
GRADE not reported
2 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Triglycerides levelSMD 1.18 [0.20, 2.15]
GRADE not reported
5 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Tissue inhibitor of metalloproteinase-4 (TIMP-4) levelSMD 0.90 [0.17, 1.63]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)C-peptide levelSMD -6.69 [-7.81, -5.58]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-6 levelSMD 1.16 [0.06, 2.25]
GRADE not reported
6 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Second mitochondria-derived activator of caspase (SMAC) levelSMD -0.53 [-1.16, 0.10]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-17 levelSMD 0.28 [-0.25, 0.81]
GRADE not reported
3 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Glucagon levelSMD 2.20 [1.64, 2.76]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Stem cell factor (SCF) levelSMD 2.41 [1.45, 3.36]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Body mass index (BMI) levelSMD 1.13 [0.21, 2.04]
GRADE not reported
7 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)4-hydroxynonenal (4-HNE) levelSMD 7.05 [5.07, 9.03]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Malondialdehyde (MDA) levelSMD 0.12 [-0.59, 0.84]
GRADE not reported
3 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Glutathione (GSH) levelSMD 0.07 [-0.74, 0.87]
GRADE not reported
3 studies
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-5 levelSMD 0.00 [-0.39, 0.38]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Toll-like receptor 4 levelSMD -0.32 [-0.83, 0.19]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Total oxidant status (TOS) levelSMD 0.28 [-0.34, 0.90]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Foxp3 levelSMD -0.15 [-0.66, 0.35]
GRADE not reported
1 study
Diabetes-related periodontitis (DMCP; periodontitis in patients with type 2 diabetes)Chronic periodontitis without diabetes (CP)Interleukin-2 levelSMD -0.47 [-1.53, 0.59]
GRADE not reported
2 studies

Included primary studies 33

Open in Studies
StudyYearAlso included byOutcomes it informs hereTrial data
Ahuja 2019
Effect of non-surgical periodontal treatment on gingival crevicular fluid and serum leptin levels in periodontally healthy chronic…
PMID:31172690
20192 other reviewsnot statednot extracted yet
Kardesler 2010
Adipokines and inflammatory mediators after initial periodontal treatment in patients with type 2 diabetes and chronic periodontitis.
PMID:20059414
20101 other reviewnot statednot extracted yet
Acharya 2015
Effect of scaling and root planing on serum interleukin-10 levels and glycemic control in chronic periodontitis and type 2 diabetes…
PMID:26015670
2015this review onlynot statednot extracted yet
Acharya 2018
Systemic Cytokines in Type 2 Diabetes Mellitus and Chronic Periodontitis.
PMID:28000545
2018this review onlynot statednot extracted yet
Akalın 2008
Superoxide dismutase activity in gingiva in type-2 diabetes mellitus patients with chronic periodontitis.
PMID:17880913
2008this review onlynot statednot extracted yet
Allen 2011
Oxidative and inflammatory status in Type 2 diabetes patients with periodontitis.
PMID:21883360
2011this review onlynot statednot extracted yet
Bakshi 2018
Estimation of Plasma Levels of Tumor Necrosis Factor-a, Interleukin-4 and 6 in Patients with Chronic Periodontitis and Type II Diabetes…
PMID:29422465
2018this review onlynot statednot extracted yet
Duarte 2012
Expression of immune-inflammatory markers in sites of chronic periodontitis in patients with type 2 diabetes.
PMID:21859322
2012this review onlynot statednot extracted yet
Duarte 2014
Local levels of inflammatory mediators in uncontrolled type 2 diabetic subjects with chronic periodontitis.
PMID:24206042
2014this review onlynot statednot extracted yet
Ghallab 2015
Expression of Leptin and Visfatin in Gingival Tissues of Chronic Periodontitis With and Without Type 2 Diabetes Mellitus: A Study Using…
PMID:25811944
2015this review onlynot statednot extracted yet
Gumus 2009
Salivary antioxidants in patients with type 1 or 2 diabetes and inflammatory periodontal disease: a case-control study.
PMID:19722794
2009this review onlynot statednot extracted yet
Guo 2018
Serum and salivary ferritin and Hepcidin levels in patients with chronic periodontitis and type 2 diabetes mellitus.
PMID:29636044
2018this review onlynot statednot extracted yet
Joseph 2015
Low levels of serum Vitamin D in chronic periodontitis patients with type 2 diabetes mellitus: A hospital-based cross-sectional clinical…
PMID:26644714
2015this review onlynot statednot extracted yet
Jung 2013
The expression of a nitric oxide derivative, tissue inhibitors of metalloproteinase-3, and tissue inhibitors of metalloproteinase-4 in…
PMID:23678392
2013this review onlynot statednot extracted yet
Kalra 2013
Association of stem cell factor and high-sensitivity C reactive protein concentrations in crevicular fluid and serum in patients with…
PMID:23485602
2013this review onlynot statednot extracted yet
Koregol 2018
8-Isoprostane in chronic periodontitis and type II diabetes: Exploring the link.
PMID:30774790
2018this review onlynot statednot extracted yet
Lobão 2024
Redox biomarkers in saliva and nuclear abnormalities in jugal epithelial cells of individuals with type 2 diabetes mellitus and…
PMID:38412774
2024this review onlynot statednot extracted yet
Miranda 2019
The ratios of pro-inflammatory to anti-inflammatory cytokines in the serum of chronic periodontitis patients with and without type 2…
PMID:29737428
2019this review onlynot statednot extracted yet
Mohamed 2015
Impact of Chronic Periodontitis on Levels of Glucoregulatory Biomarkers in Gingival Crevicular Fluid of Adults with and without Type 2…
PMID:25993052
2015this review onlynot statednot extracted yet
Patil 2016
Chronic Periodontitis in Type 2 Diabetes Mellitus: Oxidative Stress as a Common Factor in Periodontal Tissue Injury.
PMID:27190790
2016this review onlynot statednot extracted yet
Pendyala 2013
Evaluation of Total Antioxidant Capacity of Saliva in Type 2 Diabetic Patients with and without Periodontal Disease: A Case-Control Study.
PMID:23378957
2013this review onlynot statednot extracted yet
Pradeep 2012
Association of serum and crevicular visfatin levels in periodontal health and disease with type 2 diabetes mellitus.
PMID:21966944
2012this review onlynot statednot extracted yet
Pradeep 2013
4-Hydroxy-2-nonenal, an oxidative stress marker in crevicular fluid and serum in type 2 diabetes with chronic periodontitis.
PMID:24124291
2013this review onlynot statednot extracted yet
Ribeiro 2011
Cytokines and bone-related factors in systemically healthy patients with chronic periodontitis and patients with type 2 diabetes and…
PMID:21284550
2011this review onlynot statednot extracted yet
Sangappa 2024
Salivary Interleukin-6 as a Non-Invasive Biomarker for Chronic Periodontitis and Tooth Loss in Type 2 Diabetes.
PMID:38934745
2024this review onlynot statednot extracted yet
Shaker 2013
Inducible nitric oxide synthase (iNOS) in gingival tissues of chronic periodontitis with and without diabetes: immunohistochemistry and…
PMID:23830615
2013this review onlynot statednot extracted yet
Shee 2020
Cellular and Biochemical Changes in Different Categories of Periodontitis: A Patient-based Study.
PMID:32802782
2020this review onlynot statednot extracted yet
Sudhakar 2015
Opioid exposure after injury in United States trauma centers: A prospective, multicenter observational study.
PMID:32459447
2020this review onlynot statednot extracted yet
Thomas 2013
A comparative evaluation of antioxidant enzymes and selenium in the serum of periodontitis patients with diabetes mellitus type 2.
PMID:24015005
2013this review onlynot statednot extracted yet
Thomas 2014
Serum levels of antioxidants and superoxide dismutase in periodontitis patients with diabetes type 2.
PMID:25210258
2014this review onlynot statednot extracted yet
Thomas 2021
Assessment of the antioxidant levels in sera of periodontitis patients with or without diabetes mellitus
DOI:10.5958/0974-360x.2021.00183.9
2021this review onlynot statednot extracted yet
Trivedi 2014
Evaluation of antioxidant enzymes activity and malondialdehyde levels in patients with chronic periodontitis and diabetes mellitus.
PMID:23895253
2014this review onlynot statednot extracted yet
Vincent 2018
Oxidative stress in chronic periodontitis patients with type II diabetes mellitus.
PMID:29988233
2018this review onlynot statednot extracted yet

Overlap with other reviews

Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.

Review question

ElementPlanned (methods)Found (results)
PopulationPatients with a confirmed diagnosis of diabetes-related periodontitis (DMCP) and patients with chronic periodontitis (CP)Patients with periodontitis, type 2 diabetes (DMCP n=970) vs without diabetes (CP n=905)
InterventionExposure: diabetes-related periodontitis (DMCP)DMCP (n=970)
ComparisonChronic periodontitis without diabetes (CP)CP (n=905)
OutcomesExpression levels of biomarkers in both patient groupsLipid profiles; inflammatory factors and mediators; oxidative stress-related biomarkers; other biomarkers (SMD of biomarker levels)
Study designsPublished cross-sectional, case-control or cohort studies33 cross-sectional studies
TimingNot specifiedNot specified