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Periodontitis is associated with insulin resistance in adults living with diabetes mellitus in Uganda: a cross- sectional study



Evidence suggests that majority of patients with diabetes mellitus in Uganda have poor glycaemic control as well as periodontal disease. This study set out to determine the association between periodontitis and insulin resistance in adult patients with diabetes mellitus in Uganda using the triglyceride glucose index.


Two hundred and twenty-three adult study participants with confirmed diabetes mellitus were enrolled in a cross-sectional study. Oral examination was carried with the aid of a periodontal probe to determine the periodontal status and findings recorded using the WHO Oral Health Assessment Tool for Adults, 2013. We recorded clinical details for body mass index (BMI in kg/m2) and laboratory parameters including fasting blood sugar (mmol/L), glycated hemoglobin levels (HbA1c, %) and serum triglycerides (mmol/L) using a study questionnaire. Data were analyzed using R version 4.10. The glucose triglyceride index was used as a measure of insulin resistance. Logistic regression analysis carried out to determine the factors associated insulin resistance.


The majority of the study participants was female (70%) with an average age of 48.5 years (SD+/- 11.1). The mean body mass index was 29.6 kg/m2 (SD+/- 5.82). The mean serum triglyceride index was 9.48 (SD+/- 0.675). Eighty-six-point 1% of the participants had periodontal disease. Bivariate analysis revealed high odds for male sex (OR = 1.31, 95% C.I = 0.44–4.84, p = 0.65) and periodontitis (OR = 3.65, 95% C.I = 0.79–26.15, p = 0.13) but low odds for a high BMI (OR = 0.45. 95% C.I = 0.07–1.67, p = 0.30). Multivariate regression revealed a significant association between insulin resistance and periodontitis. (AOR = 3.52, 95% C.I = 1.19–1.83, p = 0.03).


Insulin resistance is highly prevalent in patients with diabetes mellitus in Uganda and is associated with periodontitis and low body weight.

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Despite the different clinical and public health interventions, the prevalence of diabetes mellitus keeps on rising, with an estimated about 463 million people reported to be affected globally by 2019 [1]. In Uganda, different studies have reported a higher prevalence of diabetes mellitus among the adult population [2, 3] .

Type 2 diabetes mellitus, primarily results from insulin resistance, an impaired target cell response to the biological effects of insulin [4]. Though a predominant feature of type 2 diabetes mellitus, insulin resistance has also been reported in patients with type 1 diabetes mellitus as evidenced by failure to restore whole body and hepatic insulin sensitivity following islet transplantation and intensive insulin treatment in these patients [5]. Insulin resistance is one of the causes of chronic hyperglycemia in patients with diabetes mellitus [6]. This prolonged hyperglycemia is responsible for the initiation and progression of diabetic complications [7]. Overweight and obesity have been identified as important risk factors for development of insulin resistance [8]. Obesity has been reported to be associated with chronic inflammation and lipotoxicity [9]. This chronic inflammation increases the risk of developing type two diabetes mellitus and insulin resistance [10]. Tomuyuki et al., [11] also identified aging to be associated with an increased risk of developing insulin resistance. Patients with advanced age have been reported to have a defect in insulin receptor action which may cause insulin resistance and carbohydrate intolerance in the elderly [12]. Furthermore, elderly individuals are more likely to be obese and this, coupled with decreased physical activity predispose such individuals to development of diabetes mellitus and insulin resistance [13]. Another important risk factor for diabetes mellitus and insulin resistance is periodontal disease [14]. About 42.4% of patients with diabetes mellitus have been reported to have periodontal disease [15] .The pro-inflammatory immunomodulators and cytokines released as a result of periodontal disease may amplify insulin resistance [16, 17]. There are different methods of determining insulin resistance. The reference method is the hyperinsuleamic euglyceamic clamp method (HEC), an in vivo method that requires constant insulin infusion and monitoring the hypoglycemic effects of insulin [18]. However, simpler methods like the Homeostasis Model Assessment for Insulin Resistance (HOMA -IR) and Triglyceride Glucose Index (TyG) can also be used to give a good picture of the degree of insulin resistance in the body [19, 20]. Although the HOMA-IR is a good indicator of insulin sensitivity, it is expensive and not readily available in most laboratories. On the other hand, the Triglyceride Glucose Index is simpler and cheaper [21]. It has also been proven to be a strong predictor for insulin resistance in participants with and without diabetes mellitus [22]. In Uganda, a large portion of patients living with diabetes mellitus have poor glycemic control [23] Unfortunately, there is scanty information about the association between periodontitis and insulin resistance. This study set out to determine the association between periodontitis and insulin resistance in adult patients with diabetes mellitus in Uganda using the Triglyceride glucose index.


Study design

This was a cross sectional study conducted between December 2021 and February 2022 at the Diabetes Out- patient Clinic in Kiruddu National Referral Hospital located in Kampala, Uganda.

Study participants

The study included 223 patients, aged 18 years and above, with a confirmed diagnosis of diabetes mellitus [24]. Participants who were pregnant, on hormonal contraceptive therapy, very sick or on broad spectrum antibiotics were excluded from the study. Written informed consent was obtained from the participants prior to enrolment in the study.

Sample size estimation

The study sample size was calculated using a formula for finite population assuming 75% proportion of participants with insulin resistance, 90% confidence interval and 5% margin of error. A 8% was added to cater for loss to follow up [25]. The study included 223 participants. Consecutive sampling method was used to obtain the required number of participants who met the inclusion criteria.


An oral examination was carried out by a trained dental surgeon to determine the community periodontal index (CPI). Periodontal status was recorded with the aid of a periodontal probe (Koushen, China) and recorded using the World Health Organization Oral Health Assessment Form For Adults, 2013. The results were interpreted as follows: 0 normal; 1 bleeding; 2 calculus; 3 pocket depth < 4 mm and 4 pocket depth > 4 mm. Participants with CPI values of 0 to 2 were reported as having no periodontitis while those with CPI values of 3 and 4 were reported as having periodontitis. The weight (kg) of the participants was measured using a calibrated weighing scale (KINLEE, China) with the participants wearing light clothing and the height (cm) using a standardised measuring tape (Boyloo, China) with the participants barefooted [26]. These were used to calculate the body mass index (kg/m2). The participants were grouped into to depending on their BMI. The normal BMI (BMI ≤ 24.9) and high BMI (BMI > 24.9). Approximately 4mls of venous blood was collected following eight hours of fasting to determine the serum triglycerides (mg/dL), fasting blood sugar levels (mg/dL) and glycated hemoglobin (HbAIc, %) using the Cobas Integra 400 plus. Insulin resistance was determined using the Triglyceride Glucose index (TyG), calculated as In [triglycerides (mg/dL) X fasting blood glucose (mg/dL)/2] [27]. Participants with a TyG index greater than 8.5 were considered to be insulin resistant [28]. The income status was determined using the monthly income in Uganda shillings. Participants earning less than four hundred thousand shillings were classified under low-income status while those earning more than four hundred thousand Uganda shillings were classified under high economic status. Smoking status was determined based on history of active smoking while frequency of tooth cleaning was determined on how often participants cleaned their teeth daily.

Data analysis

Data were entered in Microsoft excel (version 16.75.2), cleaned and exported to R (version 4.10) for analysis. Descriptive statistics were used to summarize the data. Logistic regression analysis was performed to determine the association between the different variables. The independent variables were age, BMI and periodontitis while the dependent variable was insulin resistance. All variables were retained in the Multivariate model because of their biological plausibility. The results were presented as Odds ratio with a 95% confidence interval. P-values less or equal to 0.05 were reported to be statistically significant.


Descriptive results

Of the 223 participants, 70% were females and the average age was 48.5 (SD +/ 11.1) years. (Table 1). The mean Hb1Ac (%) was 8.96 (SD+/- 2.63) and the mean BM1 (kg/m2) was 29.6 (SD+/-5.82) with 30% of the participants being underweight or normal (BMI ≤ 24.9) and the rest being overweight or obese (BMI > 24.9). The majority of participants had attained formal education. About 55.6% of the study participants were on oral hypoglycemics, 12.1% on insulin and 32.3% on combination therapy. Only 17.9% of the participants were earning more than Uganda shillings 400,000= (about United States Dollars 108) per month. The mean triglyceride glucose index was 9.48 (SD+/- 0.675) mg/dL. About 93% of the study participants had insulin resistance while 58.3% of the participants had periodontitis (Table 1).

Table 1 A table of descriptive characteristics of study participants

Factors associated with insulin resistance

Participants were assessed for the association between insulin resistance and selected variables namely age, BMI and periodontitis. Bivariate analysis revealed high odds for male sex (OR = 1.31, 95% C.I = 0.44–4.84, p = 0.65) and periodontitis (OR = 3.65, 95% C.I = 0.79–26.15, p = 0.13) but low odds for high BMI (OR = 0.45. 95% C.I = 0.07–1.67, p = 0.30). Logistic regression revealed a significant association between insulin resistance and periodontitis. (AOR = 3.52, 95% C.I = 1.19–11.83, p = 0.03) (Table 2).

Table 2 Logistic regression analysis of factors associated with insulin resistance


This study set out to determine the prevalence of insulin resistance and its association with periodontitis in participants with diabetes mellitus attending the medical outpatient clinic at a National Referral hospital in Uganda. The prevalence of insulin resistance among the study participants was 92.8% and this was significantly associated with periodontitis.

This study reports a high prevalence of insulin resistance. The prevalence of insulin resistance was more than twice that reported by Bermudez et al. [29]. However, that particular study looked at the general population while our study focused on only patients with diabetes mellitus. A large percentage of patients with diabetes mellitus in Uganda have type 2 diabetes mellitus, which is primarily associated with insulin resistance [3, 30]. This is further complicated by the inadequate and inappropriate anti-diabetic medications that has been reported amongst patients with type two diabetes mellitus [31]. The high rates may also be due to that fact that these are referral hospitals so patients who have severe forms or poorly controlled diabetes mellitus are seen.

Participants with periodontitis were three and a half times more likely to have insulin resistance than those without periodontitis. Periodontitis, being an inflammatory condition caused by gram negative bacteria, leads to a spill of inflammatory cytokines into the blood stream leading to systemic inflammation [32]. Some of these proinflammatory cytokines may amplify insulin resistance [33]. Indeed In -Seok Song et al., reported a positive association between severe periodontitis and insulin resistance even in patients with normal waist circumference [34]. Shravani Babladi et al., further demonstrated a progressive decline in insulin resistance following periodontal treatment [35]. Further studies need to be conducted to determine whether periodontal treatment is associated with a reduction in insulin resistance in the Uganda diabetic population.

Females in this study were two times more likely to have insulin resistance than males. This finding is consistent with Ramin Alemzadeh and Jessica Kichler who reported an association between insulin resistance and the female sex [36]. However, Greenhill reported that women are less susceptible to insulin resistance before menopause but the risk is similar to men after menopause, the reason for this being the protective effect of female sex hormones [37]. Our findings may be due to the older age of the study participants.

There was a negative association between a higher BMI and insulin resistance in this study. Participants who had a higher BMI had a 45% reduced chance of having insulin resistance than those with a lower BMI. This finding is contrary to Sun Min Lim et al., who reported a positive association between BMI and insulin resistance [38]. Obesity has been linked with chronic inflammation and insulin resistance [39]. However, our findings suggest a reduced risk of insulin resistance in participants who are overweight or obese. However, Umesh et al. reported insulin resistance in patients with lower BMI citing different pathways involved in this mechanism [40]. Mohammed et al., also reported insulin resistance in the non-obese participants, though his study identified an increased risk with increased BMI [41]. Though many studies grade obesity using BMI, many clinically non-obese individuals may actually be metabolically obese since the mechanisms of insulin resistance in the obese and the non-obese individuals is identical [42]. The reverse may be true where clinically obese individuals may be metabolically non- obese. This may explain why the otherwise obese participants in our study had a lower chance of having insulin resistance.

The results from this study indicate a statistically significant association between periodontitis and insulin resistance in adult patients with diabetes mellitus in Uganda. Further studies need to be conducted to determine whether periodontal treatment is associated with decreases insulin resistance in patients with diabetes mellitus in Uganda.

Limitations of the study

This study was limited by a COVID-19 and Ebola outbreaks which greatly hindered patient recruitment.

This study was also conducted in a National Referral Hospital where most of the patients with severe disease are referred to hence these results may not be generalized to the whole population.

One of the independent variables was body mass index (BMI). BMI poorly correlates with visceral adiposity compared with waist circumference and waist -hip ratio [43].

Data Availability

The data sets generated and analyzed during the current study will be available from the corresponding author on request.


  1. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res Clin Pract. 2019;157:107843. PubMed PMID: 31518657. Epub 2019/09/14. eng.

    Article  PubMed  Google Scholar 

  2. Chiwanga FS, Njelekela MA, Diamond MB, Bajunirwe F, Guwatudde D, Nankya-Mutyoba J et al. Urban and rural prevalence of diabetes and pre-diabetes and risk factors associated with diabetes in Tanzania and Uganda. Glob Health Action 2016;9:31440. PubMed PMID: 27221531. Pubmed Central PMCID: PMC4879179. Epub 2016. eng.

  3. Asiimwe D, Mauti GO, Kiconco R. Prevalence and risk factors Associated with type 2 diabetes in Elderly Patients aged 45–80 years at Kanungu District. J Diabetes Res. 2020;5152146.

  4. Bell KJ, Colagiuri S, Brand-Miller J. Chapter 20 - diabetes and insulin resistance. In: Marriott BP, Birt DF, Stallings VA, Yates AA, editors. Present Knowledge in Nutrition. Eleventh Edition): Academic Press; 2020;361–77.

    Chapter  Google Scholar 

  5. Kaul K, Apostolopoulou M, Roden M. Insulin resistance in type 1 diabetes mellitus. Metab Clin Exp. 2015;64(12):1629–39. PubMed PMID: 26455399. Epub 2015. eng.

    Article  CAS  PubMed  Google Scholar 

  6. Freeman AM, Pennings N. Insulin resistance. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022. StatPearls Publishing LLC.; 2022.

  7. Aronson D. Hyperglycemia and the pathobiology of diabetic complications. Adv Cardiol. 2008;45:1–16. PubMed PMID: 18230953. Epub 2008. eng.

    Article  CAS  PubMed  Google Scholar 

  8. Maksymets T, Karpyshyn N, Gutor T, Sklyarova H, Sklyarov E. Influence of risk factors on insulin resistance in patients with overweight and obesity. Wiadomosci lekarskie (Warsaw, Poland: 1960). 2018;71(3 pt 1):558–60. PubMed PMID: 29783224. Epub 2018. eng.

  9. Khanna D, Khanna S, Khanna P, Kahar P, Patel BM. Obesity: a chronic Low-Grade inflammation and its markers. Cureus. 2022;14(2):e22711. PubMed PMID: 35386146. Pubmed Central PMCID: PMC8967417. Epub 2022. eng.

    PubMed  PubMed Central  Google Scholar 

  10. Tong Y, Xu S, Huang L, Chen C. Obesity and insulin resistance: pathophysiology and treatment. Drug Discovery Today. 2022;27(3):822–30.

  11. Fujita T, Daimon M, Murakami H, Mizushiri S, Matsuhashi Y, Osonoi S et al. 1452-P: association between aging and insulin resistance and secretion in a General Nondiabetic Population. Diabetes. 2019;68(Supplement_1).

  12. Fink RI, Kolterman OG, Griffin J, Olefsky JM. Mechanisms of insulin resistance in aging. J Clin Investig. 1983;71(6):1523–35. PubMed PMID: 6345584. Pubmed Central PMCID: PMC370358. Epub 1983. eng.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ryan AS. Insulin resistance with aging: effects of diet and exercise. Sports medicine (Auckland, NZ). 2000;30(5):327–46. PubMed PMID: 11103847. Epub 2000. eng.

  14. Al-Maskari AY, Al-Maskari MY, Al-Sudairy S. Oral manifestations and complications of diabetes Mellitus: a review. Sultan Qaboos University Medical Journal. 2011;11(2):179–86. PubMed PMID: 21969888. Pubmed Central PMCID: PMC3121021. Epub 2011. eng.

    PubMed  PubMed Central  Google Scholar 

  15. Tefera A, Bekele B. Periodontal Disease Status and Associated Risk factors in patients attending a Tertiary Hospital in Northwest Ethiopia. Clinical, Cosmetic and Investigational Dentistry. 2020;12:485 – 92.

  16. Mealey BL, Oates TW. Diabetes mellitus and periodontal diseases. J Periodontol. 2006;77(8):1289–303. PubMed PMID: 16881798. Epub 2006. eng.

    Article  CAS  PubMed  Google Scholar 

  17. Gurav AN. Periodontitis and insulin resistance: casual or causal relationship? Diabetes Metab J. 2012;36(6):404–11. PubMed PMID: 23275933. Epub 12/12. eng.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Borai A, Livingstone C, Kaddam I, Ferns G. Selection of the appropriate method for the assessment of insulin resistance. BMC Med Res Methodol. 2011;23(1):158.

    Article  Google Scholar 

  19. de Cassia da Silva C, Zambon MP, Vasques ACJ, Camilo DF, de Góes Monteiro Antonio MR, Geloneze B. The threshold value for identifying insulin resistance (HOMA-IR) in an admixed adolescent population: a hyperglycemic clamp validated study. Archives of Endocrinology and Metabolism. 2023;67(1):119–25. PubMed PMID: 36468919. Pubmed Central PMCID: PMC9983787. Epub 2022. eng.

    PubMed  Google Scholar 

  20. Selvi NMK, Nandhini S, Sakthivadivel V, Lokesh S, Srinivasan AR, Sumathi S. Association of triglyceride-glucose index (TyG index) with HbA1c and insulin resistance in type 2 diabetes Mellitus. Maedica. 2021;16(3):375–81. PubMed PMID: 34925590. Pubmed Central PMCID: PMC8643546. Epub 2021. eng.

    PubMed  PubMed Central  Google Scholar 

  21. Hong S, Han K, Park C-Y. The triglyceride glucose index is a simple and low-cost marker associated with atherosclerotic cardiovascular disease: a population-based study. BMC Med. 2020;18(1):361. 2020.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Zhao Q, Cheng Y-J, Xu Y-K, Zhao Z-W, Liu C, Sun T-N, et al. Comparison of various insulin resistance surrogates on prognostic prediction and stratification following percutaneous coronary intervention in patients with and without type 2 diabetes mellitus. Cardiovasc Diabetol. 2021;20(1):190. 2021.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Patrick NB, Yadesa TM, Muhindo R, Lutoti S. Poor Glycemic Control and the contributing factors among type 2 diabetes Mellitus Patients attending Outpatient Diabetes Clinic at Mbarara Regional Referral Hospital, Uganda. Diabetes Metab Syndr Obes. 2021;14:3123–30. PubMed PMID: 34262316. eng.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Association AD. Standards of Medical Care in Diabetes—2021 abridged for primary care providers. Clin Diabetes. 2021;39(1):14–43.

    Article  Google Scholar 

  25. Naing L, Nordin RB, Abdul Rahman H, Naing YT. Sample size calculation for prevalence studies using scalex and ScalaR calculators. BMC Med Res Methodol. 2022;22(1):209.

  26. Crimmins E, Guyer H, Langa K, Ofstedal MB, Wallace R, Weir D. Documentation of physical measures, anthropometrics and blood pressure in the Health and Retirement Study. HRS Doc Rep DR-011. 2008;14(1–2):47–59.

    Google Scholar 

  27. Chiang JK, Lai NS, Chang JK, Koo M. Predicting insulin resistance using the triglyceride-to-high-density lipoprotein cholesterol ratio in taiwanese adults. Cardiovasc Diabetol. 2011;10:93. PubMed PMID: 22004541. Pubmed Central PMCID: PMC3224454. Epub 2011. eng.

  28. Moon S, Park JS, Ahn Y. The cut-off values of triglycerides and glucose index for metabolic syndrome in american and korean adolescents. J Korean Med Sci. 2017 2017/03//;32(3):427–33. PubMed PMID: 28145645.

  29. Bermudez V, Salazar J, Martinez MS, Chavez-Castillo M, Olivar LC, Calvo MJ, et al. Prevalence and Associated factors of insulin resistance in adults from Maracaibo City, Venezuela. Adv Prev Med. 2016;2016:9405105. PubMed PMID: 27579182. Pubmed Central PMCID: PMC4989131. Epub 2016. eng.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep. 2020;10(1):14790. 2020.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Nigussie KA, Shegena EA, Stephen OP, Namugambe JS, Yadesa TM. Prevalence and factors associated with inappropriate anti- diabetic medication therapy among type 2 diabetes mellitus patients at the medical and surgical wards of Mbarara Regional Referral Hospital, Uganda. PLoS ONE. 2022;17(6):e0270108.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Martínez-García M, Hernández-Lemus E. Periodontal inflammation and systemic Diseases: an overview. Front Physiol. 2021;12:709438. PubMed PMID: 34776994. Pubmed Central PMCID: PMC8578868. Epub 2021. eng.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gurav AN. Periodontitis and insulin resistance: casual or causal relationship? Diabetes Metab J. 2012;36(6):404–11. PubMed PMID: 23275933. Pubmed Central PMCID: PMC3530710. Epub 2013. eng.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Song I-S, Han K, Park Y-M, Ji S, Jun SH, Ryu J-J, et al. Severe periodontitis is Associated with insulin resistance in non-abdominal obese adults. J Clin Endocrinol Metabolism. 2016;101(11):4251–9.

    Article  CAS  Google Scholar 

  35. Babladi S, Agnihotri R, Gopalkrishna P, Kamath SU, Jogi S, Arun B. Influence of non-surgical periodontal therapy on insulin resistance in chronic periodontitis subjects with prediabetes. Int J Diabetes Developing Ctries. 2019;39(2):273–83.

  36. Alemzadeh R, Kichler J. Gender differences in the association of insulin resistance and high-sensitivity c-reactive protein in obese adolescents. J Diabetes Metab Disord. 2014;13(1):35. PubMed PMID: 24555754. Pubmed Central PMCID: PMC3974110. Epub 2014. eng.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Greenhill C. Sex differences in insulin resistance. Nat Reviews Endocrinol. 2018;65.

    Article  Google Scholar 

  38. Lim SM, Choi DP, Rhee Y, Kim HC. Association between obesity indices and insulin resistance among healthy korean adolescents: the JS High School Study. PLoS ONE. 2015;10(5):e0125238. PubMed PMID: 25970186. Pubmed Central PMCID: PMC4429969. Epub 2015. eng.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Gasmi A, Noor S, Menzel A, Doşa A, Pivina L, Bjørklund G. Obesity and insulin resistance: Associations with chronic inflammation, genetic and epigenetic factors. Curr Med Chem. 2021;28(4):800–26. PubMed PMID: 32838708. Epub 2020/08/26. eng.

    Article  CAS  PubMed  Google Scholar 

  40. Masharani UB, Maddux BA, Li X, Sakkas GK, Mulligan K, Schambelan M, et al. Insulin resistance in non-obese subjects is associated with activation of the JNK pathway and impaired insulin signaling in skeletal muscle. PLoS ONE. 2011;6(5):e19878. PubMed PMID: 21589939. Pubmed Central PMCID: PMC3092773. Epub 2011. eng.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Elrayess MA, Rizk NM, Fadel AS, Kerkadi A. Prevalence and predictors of insulin resistance in non-obese healthy young females in Qatar. Int J Environ Res Public Health. 2020;17(14). PubMed PMID: 32679640. Pubmed Central PMCID: PMC7399794. Epub 2020. eng.

  42. Olaogun I, Farag M, Hamid P. The pathophysiology of type 2 diabetes Mellitus in non-obese individuals: an overview of the current understanding. Cureus. 2020;12(4):e7614. PubMed PMID: 32399348. Pubmed Central PMCID: PMC7213678. Epub 2020. eng.

    PubMed  PubMed Central  Google Scholar 

  43. Buss J. Limitations of body mass index to assess body fat. Workplace health & safety. 2014 Jun;62(6):264. PubMed PMID: 24971823. Epub 2014/06/28. eng

  44. The World Medical Association. (2013). Declaration of Helsinki 2013 [Accessed 19/02/2014]; Available from:, (2013).

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We extend our sincere appreciation to MAK-RIF for sponsoring this study, the Administration of Kiruddu hospital for granting us permission to use the diabetic clinic and all the study participants.


This study was sponsored by the Government of Uganda through the Makerere University Research and Innovation Fund (MAK-RIF 1). The funding body played a role in design of the study, collection, analysis, and interpretation of data.

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H.M.K designed the study, wrote the manuscript, analyzed the data and contributed to interpretation of the results. E.S.M, M.K, I.G.M, C.M.R and W.B provided additional interpretation of the results. All the authors approved the manuscript.

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Correspondence to Haruna Muhmood Kiryowa.

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The study protocol was approved by Makerere University School of Biomedical Sciences Research and Ethics Committee (MAK SBS-REC: SBS-726) and registered by Uganda National Council of Science and Technology (UNCST: HS106ES). Informed consent was obtained from participants and confidentiality was maintained in accordance with Helsinki Declaration [44].

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Kiryowa, H.M., Munabi, I.G., Buwembo, W. et al. Periodontitis is associated with insulin resistance in adults living with diabetes mellitus in Uganda: a cross- sectional study. BMC Res Notes 16, 217 (2023).

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