Horikawa Yukio, Suzuki Akio, Enya Mayumi, Hashimoto Ken-Ichi, Nishida Shohei, Kobayashi Ryo, Ohashi Tetsuya, Yamazaki Futoshi, Totani Rieko, Kobayashi Hiroshi, Yamamoto Mayumi, Itoh Yoshinori, Takeda Jun
Department of Diabetes and Endocrinology, Gifu University Graduate School of Medicine, Gifu, Japan.
Department of Pharmacy, Gifu University Hospital, Gifu, Japan.
Exp Clin Endocrinol Diabetes. 2020 Apr;128(4):231-238. doi: 10.1055/a-0879-1890. Epub 2019 Apr 11.
A questionnaire survey of the prevalence of diabetic retinopathy was recently conducted in Japan. A subgroup analysis to examine the association of periodontal disease with diabetic retinopathy in subjects with diabetes and prediabetes was conducted.
The association of the presence of periodontal disease with the occurrence of diabetic retinopathy was examined using multivariate logistic regression analysis.
Of 27 016 subjects who completed a survey at 217 community pharmacies, 5 572 had diabetes or prediabetes, among whom 522 and 1 421 had retinopathy or periodontal disease, respectively. Therapy duration≥10 years (OR: 2.73, 95% CI: 2.17-3.43, P<0.001), periodontal disease (OR: 2.10, 95% CI: 1.68-2.62, P<0.001) and glycated hemoglobin (HbA1c) ≥ 7.0% (OR: 1.64, 95% CI: 1.32-2.04, P<0.001) were significantly associated with the occurrence of retinopathy, while retinopathy (OR: 2.11, 95% CI: 1.: 69-2.63, P<0.001) and therapy duration ≥10 years (OR: 1.24, 95% CI: 1.06-1.46, P=0.007) were significantly associated with the occurrence of periodontal disease. The prevalence of retinopathy was much higher in diabetic subjects with periodontal disease than in those without it (15.1% vs. 7.8%, P<0.001). Notably, the difference of prevalence of retinopathy between subjects with and without periodontal disease was statistically significant even at HbA1c 6.0-6.9% (15.2% vs. 7.3%, P<0.01).
These findings indicate that the target HbA1c level for diabetes patients with periodontal disease may be set lower than for those without it, and that regular dental visits should be prescribed for the management of periodontal disease and the prevention of diabetic retinopathy.
近期在日本开展了一项关于糖尿病视网膜病变患病率的问卷调查。对糖尿病和糖尿病前期患者中牙周疾病与糖尿病视网膜病变的关联进行了亚组分析。
采用多因素逻辑回归分析研究牙周疾病的存在与糖尿病视网膜病变发生之间的关联。
在217家社区药房完成调查的27016名受试者中，5572人患有糖尿病或糖尿病前期，其中分别有522人和1421人患有视网膜病变或牙周疾病。治疗时长≥10年（比值比：2.73，95%置信区间：2.17 - 3.43，P<0.001）、牙周疾病（比值比：2.10，95%置信区间：1.68 - 2.62，P<0.001）和糖化血红蛋白（HbA1c）≥7.0%（比值比：1.64，95%置信区间：1.32 - 2.04，P<0.001）与视网膜病变的发生显著相关，而视网膜病变（比值比：2.11，95%置信区间：1.69 - 2.63，P<0.001）和治疗时长≥10年（比值比：1.24，95%置信区间：1.06 - 1.46，P = 0.007）与牙周疾病的发生显著相关。患有牙周疾病的糖尿病患者中视网膜病变的患病率远高于未患牙周疾病的患者（15.1%对7.8%，P<0.001）。值得注意的是，即使在HbA1c为6.0 - 6.9%时，有和没有牙周疾病的受试者之间视网膜病变患病率的差异也具有统计学意义（15.2%对7.3%，P<0.01）。
这些发现表明，患有牙周疾病的糖尿病患者糖化血红蛋白的目标水平可能应设定得比未患牙周疾病的患者更低，并且应为牙周疾病的管理和糖尿病视网膜病变的预防安排定期牙科检查。
