Effect and mechanism of fluctuant glucose on restraining implant osseointegration in diabetes

Abstract Objectives The objectives of the study was to discuss the effect and mechanism of fluctuant glucose (FG) on implant osseointegration in type 2 diabetic mellitus (T2DM). Materials and Methods Rats were divided into control, T2DM and FG group, and the implants were inserted into their femurs. Micro‐CT and histological analysis were used to evaluate the effect on osseointegration in vivo. And we investigated the effect of different conditions (normal, control, high glucose, and FG medium) on rat osteoblast in vitro. Then transmission electron microscope (TEM) and Western blot were used to evaluate the endoplasmic reticulum stress (ERS) response. Finally, 4‐PBA, an inhibitor of ERS, was added into different conditions to observe the functions of osteoblast. Results In vivo, Micro‐CT and histological analysis showed that the percentage of osseointegration in FG rats were lower than other two group. In vitro, the results demonstrated that the adhesion of the cells becomes worst, and osteogenic ability was also severely impaired in FG group. In addition, FG could induce more serious ERS and 4‐PBA could improve the dysfunction of osteoblasts induced by FG. Conclusion Fluctuant glucose could restrain the implant osseointegration in T2DM, and the effect was more obvious than consistent high glucose by a possible mechanism of activation ERS pathway.