Wang Tze-Fang, Jen I-An, Chou Chyuan, Lei Yen-Ping
From the School of Nursing, National Yang Ming University, Taipei, Taiwan (TFW, YPL); Institute of Public Health, National Yang Ming University, Taipei, Taiwan (IAJ); Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA (CC); Center for Reproductive Medicine and Sciences, Taipei Medical University, Taipei, Taiwan (YPL).
Medicine (Baltimore). 2014 Dec;93(28):e292. doi: 10.1097/MD.0000000000000292.
Epidemiologic studies have reported increased incidence, prevalence and acuity of periodontitis in adults with diabetes and some have also suggested that treating periodontal disease may improve glycemic control in diabetic patients. This meta-analysis was conducted to evaluate the effects of different periodontal therapies on metabolic control in patients with type 2 diabetes mellitus (T2DM) and periodontal disease. We searched the Medline, EMBASE and Cochrane Library (Central) databases up to January 2014 for relevant studies pertaining to periodontal treatments and glycemic control in adults with T2DM. The search terms were periodontal treatment/periodontal therapy, diabetes/diabetes mellitus, periodontitis/periodontal and glycemic control. The primary outcome measure taken from the included studies was glycated hemoglobin (HbA1c). We compared differences in patients' pre- and post-intervention HbA1c results between a treatment group receiving scaling and root planing (SRP) combined with administration of oral doxycycline (n=71) and controls receiving SRP alone or SRP plus placebo (n=72). Meta-analysis was performed using Comprehensive Meta Analysis software. Nineteen randomized controlled trials (RCTs) were identified. Four trials involving a total of 143 patients with T2DM and periodontal disease were determined to be eligible for analysis. Data of 1 study were not retained for meta-analysis because HbA1c results were recorded as median with IQR. Meta-analysis of the included 3 studies revealed no significant differences in HbA1c results between the periodontal treatment group (n=71) and control group (n=72) (HbA1c SMD=-0.238, 95% CI=-0.616 to 0.140; P=0.217). Systemic doxycycline added to SRP does not significantly improve metabolic control in patients with T2DM and chronic periodontitis. Current evidence is insufficient to support a significant association between periodontal therapy and metabolic control in this patient population. However, evidence suggests that periodontal therapy itself improves metabolic control and reinforces that T2DM is a risk factor for periodontitis.
流行病学研究报告称，糖尿病成年人牙周炎的发病率、患病率和严重程度有所增加，一些研究还表明，治疗牙周疾病可能改善糖尿病患者的血糖控制。本荟萃分析旨在评估不同牙周治疗对2型糖尿病（T2DM）合并牙周疾病患者代谢控制的影响。我们检索了截至2014年1月的Medline、EMBASE和Cochrane图书馆（Central）数据库，以查找与T2DM成年人牙周治疗和血糖控制相关的研究。检索词为牙周治疗/牙周疗法、糖尿病/糖尿病 mellitus、牙周炎/牙周和血糖控制。纳入研究的主要结局指标是糖化血红蛋白（HbA1c）。我们比较了接受龈上洁治和根面平整（SRP）联合口服强力霉素治疗的治疗组（n=71）与仅接受SRP或SRP加安慰剂的对照组（n=72）患者干预前后HbA1c结果的差异。使用综合荟萃分析软件进行荟萃分析。共识别出19项随机对照试验（RCT）。确定4项涉及总共143例T2DM合并牙周疾病患者的试验符合分析条件。由于HbA1c结果记录为中位数及四分位间距，1项研究的数据未保留用于荟萃分析。对纳入的3项研究进行的荟萃分析显示，牙周治疗组（n=71）和对照组（n=72）的HbA1c结果无显著差异（HbA1c标准化均数差=-0.238，95%可信区间=-0.6１6至0.140；P=0.217）。在SRP基础上加用全身强力霉素并不能显著改善T2DM合并慢性牙周炎患者的代谢控制。目前的证据不足以支持该患者群体中牙周治疗与代谢控制之间存在显著关联。然而，有证据表明牙周治疗本身可改善代谢控制，并强化了T2DM是牙周炎的一个危险因素这一观点。
