Psychological and clinical factors in periodontal improvement in people with T2DM

Periodontal disease is highly prevalent among individuals with type 2 diabetes mellitus (T2DM) and shows a bidirectional relationship with glycemic control. The transtheoretical model of behavior change suggests that motivation is associated with the adoption of health habits, and although it is useful for understanding how adherence to self-care fluctuates, and for designing specific interdisciplinary programs related to individuals' motivational stage, its relationship with periodontal health in T2DM remains underexplored. This study aim to analyze the clinical and motivational factors associated with periodontal health in individuals with recently diagnosed T2DM. A retrospective observational study was conducted in 2,999 patients with T2DM diagnosed less than 5 years prior, enrolled in a multidisciplinary care program at a tertiary care hospital in Mexico City. Periodontal parameters and stage of change (baseline and 3 months) were assessed. Generalized ordinal and binary logistic regression models were applied, adjusted for age, sex, and HbA1c. Advancing in the stage of change was significantly associated with better periodontal diagnosis (OR = 1.50; 95% CI: 1.22-1.83), better oral hygiene (OR = 2.42; 95% CI: 2.03-2.88), and reduced bleeding on probing (OR = 1.67; 95% CI: 1.39-2.01). Being a woman, achieving HbA1c targets, and longer follow-up also increased the likelihood of improvement. Advanced motivational stages were associated with better periodontal status and oral hygiene among the study population. The motivational stage may be useful for identifying patients who may benefit from tailored support. Due to the study design and the absence of a control group, these findings should not be interpreted as evidence of causality.