Taylor G W, Burt B A, Becker M P, Genco R J, Shlossman M, Knowler W C, Pettitt D J
University of Michigan School of Dentistry, Ann Arbor, USA.
J Periodontol. 1996 Oct;67(10 Suppl):1085-93. doi: 10.1902/jop.1996.67.10s.1085.
This study tested the hypothesis that severe periodontitis in persons with non-insulin-dependent diabetes mellitus (NIDDM) increases the risk of poor glycemic control. Data from the longitudinal study of residents of the Gila River Indian Community were analyzed for dentate subjects aged 18 to 67, comprising all those: 1) diagnosed at baseline with NIDDM (at least 200 mg/dL plasma glucose after a 2-hour oral glucose tolerance test); 2) with baseline glycosylated hemoglobin (HbA1) less than 9%; and 3) who remained dentate during the 2-year follow-up period. Medical and dental examinations were conducted at 2-year intervals. Severe periodontitis was specified two ways for separate analyses: 1) as baseline periodontal attachment loss of 6 mm or more on at least one index tooth; and 2) baseline radiographic bone loss of 50% or more on at least one tooth. Clinical data for loss of periodontal attachment were available for 80 subjects who had at least one follow-up examination, 9 of whom had two follow-up examinations at 2-year intervals after baseline. Radiographic bone loss data were available for 88 subjects who had at least one follow-up examination, 17 of whom had two follow-up examinations. Poor glycemic control was specified as the presence of HbA, of 9% or more at follow-up. To increase the sample size, observations from baseline to second examination and from second to third examinations were combined. To control for non-independence of observations, generalized estimating equations (GEE) were used for regression modeling. Severe periodontitis at baseline was associated with increased risk of poor glycemic control at follow-up. Other statistically significant covariates in the GEE models were: 1) baseline age; 2) level of glycemic control at baseline; 3) having more severe NIDDM at baseline; 4) duration of NIDDM; and 5) smoking at baseline. These results support considering severe periodontitis as a risk factor for poor glycemic control and suggest that physicians treating patients with NIDDM should be alert to the signs of severe periodontitis in managing NIDDM.
非胰岛素依赖型糖尿病（NIDDM）患者的重度牙周炎会增加血糖控制不佳的风险。对吉拉河印第安社区居民纵向研究的数据进行了分析，研究对象为18至67岁的有牙受试者，包括所有符合以下条件的人：1）在基线时被诊断为NIDDM（口服葡萄糖耐量试验2小时后血浆葡萄糖至少200mg/dL）；2）基线糖化血红蛋白（HbA1）低于9%；3）在2年随访期内仍有牙齿。每2年进行一次医学和牙科检查。重度牙周炎通过两种方式进行界定以分别分析：1）至少一颗指数牙的基线牙周附着丧失6mm或更多；2）至少一颗牙的基线放射学骨丧失50%或更多。80名至少进行过一次随访检查的受试者有牙周附着丧失的临床数据，其中9人在基线后每2年进行了两次随访检查。88名至少进行过一次随访检查的受试者有放射学骨丧失数据，其中17人进行了两次随访检查。血糖控制不佳被界定为随访时HbA1≥9%。为了增加样本量，将基线至第二次检查以及第二次至第三次检查的观察结果合并。为了控制观察结果的非独立性，采用广义估计方程（GEE）进行回归建模。基线时的重度牙周炎与随访时血糖控制不佳风险增加相关。GEE模型中其他具有统计学意义的协变量为：1）基线年龄；2）基线时的血糖控制水平；3）基线时NIDDM病情更严重；4）NIDDM病程；5）基线时吸烟。这些结果支持将重度牙周炎视为血糖控制不佳的一个风险因素，并表明治疗NIDDM患者的医生在管理NIDDM时应警惕重度牙周炎的体征。
