Faggion C M, Cullinan M P, Atieh M
Department of Periodontology and Operative Dentistry, Faculty of Dentistry, University of Münster, Münster, Germany.
Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
J Periodontal Res. 2016 Dec;51(6):716-725. doi: 10.1111/jre.12358. Epub 2016 Feb 23.
Several systematic reviews with meta-analyses on the effectiveness of periodontal treatment to improve glycaemic control have been published. So far no overview of these systematic reviews has been performed. The main objective of this report was to assess critically these systematic reviews to provide the reader with a high-level synthesis of research evidence. MEDLINE (via PubMed) and EMBASE databases were searched independently and in duplicate to identify systematic reviews with meta-analyses of clinical studies that assessed the relationship between diabetes mellitus and periodontitis. The last database search was performed on 10 March 2015. The reference lists of included systematic reviews were also scrutinized for further publications. The methodological quality of the included systematic reviews was assessed independently with two validated checklists (AMSTAR and OQAQ) by two authors. Disagreements in the assessment were resolved by consensus. A total of 226 potential publications were initially retrieved. Eleven systematic reviews with meta-analyses were finally included. Glycosylated haemoglobin A1c (HbA1c) was the most commonly used clinical endpoint. Meta-analytic estimates from systematic reviews generated an average reduction of 0.46% (median 0.40%) of HbA1c in patients with diabetes mellitus who received periodontal treatment. These meta-analyses had, nevertheless, methodological limitations such as inclusion of trials with different types of risk of bias that hinder more robust conclusions. A recent meta-analysis that included recently published large randomized controlled trials did not show significant change in the level of HbA1c at the 6 mo follow-up. The AMSTAR checklist generated results that were more conservative than OQAQ. Findings from this overview do not support the information that periodontal treatment may improve glycaemic control. Methodological issues described in this overview may guide further research on this topic.
关于牙周治疗改善血糖控制效果的多项系统评价及荟萃分析已发表。到目前为止，尚未对这些系统评价进行综述。本报告的主要目的是对这些系统评价进行严格评估，为读者提供高水平的研究证据综合。独立且重复检索MEDLINE（通过PubMed）和EMBASE数据库，以识别对评估糖尿病与牙周炎关系的临床研究进行系统评价及荟萃分析的文献。最后一次数据库检索于2015年3月10日进行。对纳入的系统评价的参考文献列表也进行了仔细审查以查找更多相关出版物。由两位作者使用两个经过验证的清单（AMSTAR和OQAQ）独立评估纳入的系统评价的方法学质量。评估中的分歧通过协商一致解决。最初共检索到226篇潜在出版物。最终纳入了11项进行了荟萃分析的系统评价。糖化血红蛋白A1c（HbA1c）是最常用的临床终点。系统评价的荟萃分析估计，接受牙周治疗的糖尿病患者的HbA1c平均降低了0.46%（中位数为0.40%）。然而，这些荟萃分析存在方法学局限性，例如纳入了具有不同偏倚风险类型的试验，这阻碍了得出更可靠的结论。一项最近的荟萃分析纳入了最近发表的大型随机对照试验，结果显示在6个月随访时HbA1c水平没有显著变化。AMSTAR清单得出的结果比OQAQ更保守。本综述的结果不支持牙周治疗可能改善血糖控制这一观点。本综述中描述的方法学问题可能会指导该主题的进一步研究。
