Islam S K M Azizul, Seo Minchul, Lee Young-Sil, Moon Seong-Su
Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju, South Korea.
Endocr J. 2015;62(11):981-9. doi: 10.1507/endocrj.EJ15-0350. Epub 2015 Sep 1.
Periodontitis and insulin resistance (IR) show bidirectional relationship. No studies have assessed the associations of periodontitis with IR, impaired β-cell function, and impaired fasting glucose (IFG) in the general population. We investigated these associations in a representative sample of the Korean population. The subjects were 8,248 males and 10,874 females, who were ≥ 20 years of age and participants in the third, fourth, and fifth Korea National Health and Nutritional Examination Surveys (2008-2010). Periodontitis was defined as community periodontal index (CPI) ≥ code 3 according to World Health Organization criteria. Homeostasis model assessments of IR and β-cell function (HOMA-IR and HOMA-β) were calculated. Participants with periodontitis showed a higher prevalence of diabetes than those without periodontitis. Among subjects without diabetes, after adjustment for confounding factors including age, gender, body mass index, systolic blood pressure, serum total cholesterol, smoking status, alcohol consumption, region, and regular exercise, a comparison of participants with periodontitis vs those without showed a significantly higher prevalence of IFG (28.5% vs. 17.7%, p<0.001) and lower HOMA-β (115.2 vs. 130.8, p<0.001). Periodontitis was identified as a risk factor for IFG (OR, 1.301; 95% CI, 1.193∼1.418; p<0.001). Conversely, participants with and without periodontitis had similar HOMA-IR. In conclusion, periodontitis showed an association with decreased β-cell function and increased prevalence of IFG before onset of diabetes as well as increased prevalence of diabetes in the Korean population. Future longitudinal studies are warranted to elucidate the shared pathophysiology between periodontal disease and diabetes mellitus.
牙周炎与胰岛素抵抗（IR）呈现双向关系。尚无研究评估普通人群中牙周炎与IR、β细胞功能受损及空腹血糖受损（IFG）之间的关联。我们在韩国人群的代表性样本中调查了这些关联。研究对象为8248名男性和10874名女性，年龄≥20岁，参与了第三、第四和第五次韩国国家健康与营养检查调查（2008 - 2010年）。根据世界卫生组织标准，牙周炎定义为社区牙周指数（CPI）≥3级。计算了IR和β细胞功能的稳态模型评估指标（HOMA - IR和HOMA - β）。患有牙周炎的参与者患糖尿病的患病率高于未患牙周炎者。在无糖尿病的受试者中，在对包括年龄、性别、体重指数、收缩压、血清总胆固醇、吸烟状况、饮酒量、地区和规律运动等混杂因素进行调整后，比较患有牙周炎与未患牙周炎的参与者，结果显示IFG的患病率显著更高（28.5%对17.7%，p<0.001），且HOMA - β更低（115.2对130.8，p<0.001）。牙周炎被确定为IFG的一个危险因素（比值比，1.301；95%置信区间，1.193～1.418；p<0.001）。相反，患有和未患牙周炎的参与者HOMA - IR相似。总之，在韩国人群中，牙周炎与糖尿病发病前β细胞功能下降、IFG患病率增加以及糖尿病患病率增加有关。未来有必要进行纵向研究以阐明牙周疾病与糖尿病之间共同的病理生理学机制。
