From a physiopathological point of view, progressive insulin and glycemic dysfunction with insulin resistance and subsequent prediabetes in severe forms of CP could be the consequence of chronically increased levels of proinflammatory cytokines, as reported elsewhere.24,42 Demmer et al12 proposed the alternative hypothesis that metabolic disorders could be related to the dysbiotic microbial communities found in periodontitis. Here, INS is linked to periodontitis.