# Association of glycemic variability and sociodemographic determinants with periodontal health in children with type 1 diabetes: a cross-sectional study from Türkiye

## TL;DR

Children with type 1 diabetes have worse periodontal health than healthy peers, with some evidence linking hypoglycemia to plaque and gum inflammation.

## Contribution

This study explores the association between glycemic variability and periodontal health in children with type 1 diabetes using CGM metrics.

## Key findings

- Children with T1DM had significantly higher plaque, gingival, and periodontal indices compared to healthy controls.
- Higher time below range (TBR) hypoglycemia correlated with increased plaque and gingival inflammation in T1DM children.
- Maternal education was associated with lower dental caries in children, but no differences were found in rural versus urban residence.

## Abstract

Periodontal complications are frequently reported in youth with type 1 diabetes (T1DM), yet evidence linking continuous glucose monitoring (CGM) metrics to pediatric periodontal status is limited. We assessed periodontal health in T1DM versus healthy peers and examined associations of HbA1c and CGM-derived metrics—including coefficient of variation (CV), time in range (TIR), and time below range (TBR)—with periodontal indices, alongside sociodemographic determinants.

In this single-center cross-sectional study (age 7–12 years), T1DM participants (n = 52) were compared with healthy controls (n = 26). Periodontal outcomes were Plaque Index (PI), Gingival Index (GI), and simplified Basic Periodontal Examination (s-BPE). CGM summaries (preceding 14–30 days) were obtained for T1DM only. Caries experience (dmft/DMFT) was recorded as an oral-health descriptor. Group comparisons used Kruskal–Wallis/Dunn tests; associations used Spearman correlations and multivariable linear regression adjusting for age, sex, parental ages, education, and household income.

Compared with controls, T1DM showed higher PI, GI, and s-BPE (all p < 0.001). Xerostomia was more frequent in T1DM (30.8% vs. 0%; p = 0.004). Periodontal indices did not differ between HbA1c (< 7% vs. ≥ 7%) or CV (< 36% vs. ≥ 36%) strata. Within T1DM, TBR < 70 mg/dL correlated weakly but positively with PI (ρ = 0.312; p = 0.024) and GI (ρ = 0.316; p = 0.022). In adjusted analyses restricted to the T1DM cohort, time below range < 54 mg/dL (TBR < 54) was positively associated with the plaque index. For the gingival index, small associations were observed with time in range (TIR) and glycemic variability (CV); however, these were directionally inconsistent with biological expectations and should be interpreted cautiously. No predictors were identified for the s-BPE screening outcome. dmft/DMFT did not differ across groups; maternal education associated with lower DMFT (p < 0.05). Rural–urban residence showed no differences.

Children with T1DM exhibit poorer periodontal health than healthy peers. An exploratory link between higher hypoglycemia burden (TBR) and greater plaque/gingival inflammation suggests a modifiable behavioral conduit—hypoglycemia management and night-time hygiene—superimposed on salivary dysfunction and social determinants. Findings support integrating CGM-informed counseling on free-sugar exposure and oral hygiene into pediatric diabetes care and align with SDG-3 goals to strengthen prevention within routine services.

The online version contains supplementary material available at 10.1186/s12903-025-07484-z.