Department of Dentistry and Oral Health, Section for Periodontology, Aarhus University, Aarhus, Denmark.
Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
J Dent Res. 2023 Sep;102(10):1088-1097. doi: 10.1177/00220345231179897. Epub 2023 Jul 14.
Periodontitis is a common finding among people with diabetes mellitus (DM) and has been cited as a DM complication. Whether and how periodontitis relates to other diabetes-related complications has yet to be explored. This study aims to examine the clustering of periodontitis with other diabetes-related complications and explore pathways linking diabetes-related complications with common risk factors. Using data from participants with DM across 3 cycles of the National Health and Nutrition Examination Survey (NHANES) ( = 2,429), we modeled direct and indirect pathways from risk factors to diabetes-related complications, a latent construct comprising periodontitis, cardiovascular diseases, proteinuria, and hypertension. Covariates included age, sex, socioeconomic status (SES), smoking, physical activity, healthy diet, alcohol consumption, hemoglobin A1c (HbA1c), dyslipidemia, and body mass index (BMI). Sensitivity analyses were performed considering participants with overweight/obesity and restricting the sample to individuals without DM. Periodontitis clustered with other diabetes complications, forming a latent construct dubbed diabetes-related complications. In NHANES III, higher HbA1c levels and BMI, older age, healthy diet, and regular physical activity were directly associated with the latent variable diabetes-related complications. In addition, a healthy diet and BMI had a total effect on diabetes-related complications. Although sex, smoking, dyslipidemia, and SES demonstrated no direct effect on diabetes-related complications in NHANES III, a direct effect was observed using NHANES 2011-2014 cycles. Sensitivity analysis considering participants with overweight/obesity and without DM showed consistent results. Periodontal tissue breakdown seems to co-occur with multiple diabetes-related complications and may therefore serve as a valuable screening tool for other well-known diabetes-related complications.
牙周炎在糖尿病患者中很常见，并被认为是糖尿病的一种并发症。牙周炎与其他糖尿病相关并发症的关系以及它们之间的联系途径仍有待探索。本研究旨在探讨牙周炎与其他糖尿病相关并发症的聚类情况，并探讨将糖尿病相关并发症与常见危险因素联系起来的途径。本研究使用了来自国家健康和营养检查调查（NHANES）三个周期的糖尿病患者的数据（n=2429），我们构建了一个潜在结构模型，该模型包含牙周炎、心血管疾病、蛋白尿和高血压，用以模拟从危险因素到糖尿病相关并发症的直接和间接途径。协变量包括年龄、性别、社会经济状况（SES）、吸烟、身体活动、健康饮食、饮酒、糖化血红蛋白（HbA1c）、血脂异常和体重指数（BMI）。考虑到超重/肥胖的参与者和限制无糖尿病的样本，进行了敏感性分析。牙周炎与其他糖尿病并发症聚类，形成一个潜在的结构，称为糖尿病相关并发症。在 NHANES III 中，较高的 HbA1c 水平和 BMI、年龄较大、健康饮食和定期身体活动与潜在变量糖尿病相关并发症直接相关。此外，健康饮食和 BMI 对糖尿病相关并发症有总效应。尽管在 NHANES III 中，性别、吸烟、血脂异常和 SES 对糖尿病相关并发症没有直接影响，但在 NHANES 2011-2014 周期中观察到了直接影响。考虑到超重/肥胖和无糖尿病的参与者的敏感性分析显示出一致的结果。牙周组织破坏似乎与多种糖尿病相关并发症同时发生，因此可能成为其他著名的糖尿病相关并发症的有价值的筛查工具。
