To evaluate whether periodontal disease is related with incident diabetes across the body mass index (BMI) spectrum, and to test the hypothesis that BMI modifies the periodontal risk for incident diabetes. The study enrolled 5569 diabetes-free Atherosclerosis Risk in Communities study participants from Visit 4 and tracked them till 2018. Periodontal disease state was determined using the periodontal profile class (PPC)-Stages, and incident diabetes was determined using participant reports of physician diagnosis. For each PPC-Stage, it calculated the hazard ratios (HR) for diabetes using a competing risk model. It looked at the multiplicative effects of periodontal disease and BMI on diabetes risk. 1348 incident diabetes cases and 1529 fatalities occurred over a median of 19.4 years of follow-up. Participants with PPC “Severe Periodontal Disease” or “Severe Tooth Loss” and lower BMI had an increased risk of diabetes after adjusting for demographic, smoking, education, and biological variables and accounting for death as a competing risk, with HRs of 1.76 and 2.11, respectively, when compared to the “Health/Incidental Disease” stage. PPC-Stages and BMI had a significant relationship. When BMI was more than 31 kg/m2, there were no significant correlations between PPC-Stages and incident diabetes.

Periodontal disease was linked to incident diabetes, particularly among nonobese individuals. Periodontal disease is related with incident diabetes, although the connection may be reduced for patients with higher BMI levels, according to dentists.