Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Periodontal Department, 251 General Air Force Hospital, Athens, Greece.
Clin Oral Investig. 2019 Dec;23(12):4365-4370. doi: 10.1007/s00784-019-02888-y. Epub 2019 Apr 9.
The objective of the present study was to implement a chairside diabetes screening strategy for the identification of undiagnosed hyperglycaemia in periodontal patients.
Measurement of HbA1c was performed in patients (n = 139) diagnosed with periodontal disease to determine possible unknown hyperglycaemia. Patients fulfilled the criteria for screening according to the questionnaire by the Centers for Disease Control and Prevention (CDC). The Cobas® b101 in vitro diagnostic system was used for the measurement of glycosylated haemoglobin (HbA1c) in capillary blood. Body mass index (BMI) and waist circumference were also measured to determine splanchnic obesity. Periodontal parameters were assessed with an automated probe and included probing depth, clinical attachment loss, bleeding on probing and presence/absence of plaque.
Most patients had moderate periodontitis. Almost 25% of the subjects tested were found to have unknown hyperglycaemia while 80.5% of them had splanchnic obesity. A significant association was found between HbA1c and BMI (Mann-Whitney test; p = 0.0021) as well as between HbA1c and waist circumference (Spearman rho test; p = 0.0007). No differences were observed regarding periodontal parameters between subjects exhibiting HbA1c ≥ 5.7% and those with HbA1c < 5.7% (Mann-Whitney test; p > 0.05) although those with HbA1c ≥ 5.7% displayed higher proportions of sites with clinical attachment loss > 5 mm (z test with Bonferroni corrections; p < 0.05).
Periodontal patients, especially those with a bigger than normal BMI and waist circumference, are a target group worth screening for diabetes.
The dental practitioner can contribute significantly to the worldwide effort of health care professionals in diabetes screening and referring for early diagnosis of the disease.
本研究旨在实施一种椅旁糖尿病筛查策略，以发现牙周病患者中未确诊的高血糖。
对诊断为牙周病的患者（n=139）进行糖化血红蛋白（HbA1c）测量，以确定可能存在的未知高血糖。患者根据疾病控制与预防中心（CDC）的问卷标准符合筛查条件。采用罗氏 Cobas® b101 体外诊断系统检测毛细血管全血中的糖化血红蛋白（HbA1c）。还测量了体重指数（BMI）和腰围，以确定内脏肥胖。采用自动探头评估牙周参数，包括探诊深度、临床附着丧失、探诊出血和菌斑的存在/缺失。
大多数患者患有中度牙周炎。测试的受试者中近 25%被发现患有未知高血糖，而其中 80.5%患有内脏肥胖。HbA1c 与 BMI（Mann-Whitney 检验；p=0.0021）以及 HbA1c 与腰围（Spearman rho 检验；p=0.0007）之间存在显著相关性。HbA1c≥5.7%和 HbA1c<5.7%的受试者之间的牙周参数无差异（Mann-Whitney 检验；p>0.05），尽管 HbA1c≥5.7%的受试者中临床附着丧失>5mm 的位点比例更高（z 检验，Bonferroni 校正；p<0.05）。
牙周病患者，尤其是 BMI 和腰围大于正常的患者，是值得进行糖尿病筛查的目标群体。
牙医可以为全球医疗保健专业人员在糖尿病筛查和转诊以早期诊断疾病方面做出重大贡献。
