Taylor G W, Burt B A, Becker M P, Genco R J, Shlossman M
School of Dentistry, University of Michigan, Ann Arbor, USA.
Ann Periodontol. 1998 Jul;3(1):30-9. doi: 10.1902/annals.1998.3.1.30.
This study tested the hypothesis that the risk for alveolar bone loss is greater, and bone loss progression more severe, for subjects with poorly controlled (PC) type 2 diabetes mellitus (type 2 DM) compared to those without type 2 DM or with better controlled (BC) type 2 DM. The PC group had glycosylated hemoglobin (HbA1) > or = 9%; the BC group had HbA1 < 9%. Data from the longitudinal study of the oral health of residents of the Gila River Indian Community were analyzed. Of the 359 subjects, aged 15 to 57 with less than 25% radiographic bone loss at baseline, 338 did not have type 2 DM, 14 were BC, and 7 were PC. Panoramic radiographs were used to assess interproximal bone level. Bone scores (scale 0-4) corresponding to bone loss of 0%, 1% to 24%, 25% to 49%, 50% to 74%, or > or = 75% were used to identify the worst bone score (WBS) in the dentition. Change in worst bone score at follow-up, the outcome, was specified on a 4-category ordinal scale as no change, or a 1-, 2-, 3-, or 4-category increase over baseline WBS (WBS1). Poorly controlled diabetes, age, calculus, time to follow-up examination, and WBS1 were statistically significant explanatory variables in ordinal logistic regression models. Poorly controlled type 2 DM was positively associated with greater risk for a change in bone score (compared to subjects without type 2 DM) when the covariates were included in the model. The cumulative odds ratio (COR) at each threshold of the ordered response was 11.4 (95% CI = 2.5, 53.3). When contrasted with subjects with BC type 2 DM, the COR for those in the PC group was 5.3 (95% CI = 0.8, 53.3). The COR for subjects with BC type 2 DM was 2.2 (95% CI = 0.7, 6.5), when contrasted to those without type 2 DM. These results suggest that poorer glycemic control leads to both an increased risk for alveolar bone loss and more severe progression over those without type 2 DM, and that there may be a gradient, with the risk for bone loss progression for those with better controlled type 2 DM intermediate to the other 2 groups.
与没有2型糖尿病或血糖控制较好（BC）的2型糖尿病患者相比，血糖控制不佳（PC）的2型糖尿病患者发生牙槽骨丧失的风险更高，且骨质丧失进展更严重。PC组糖化血红蛋白（HbA1）≥9%；BC组HbA1＜9%。对吉拉河印第安社区居民口腔健康纵向研究的数据进行了分析。在359名年龄在15至57岁、基线时影像学骨质丧失少于25%的受试者中，338人没有2型糖尿病，14人血糖控制良好，7人血糖控制不佳。使用全景X线片评估邻间骨水平。对应于骨质丧失0%、1%至24%、25%至49%、50%至74%或≥75%的骨评分（0 - 4级）用于确定牙列中最差骨评分（WBS）。随访时最差骨评分的变化作为结果，在一个4分类有序量表上规定为无变化，或相对于基线WBS（WBS1）增加1、2、3或4个等级。在有序逻辑回归模型中，血糖控制不佳、年龄、牙石、随访检查时间和WBS1是具有统计学意义的解释变量。当模型中纳入协变量时，血糖控制不佳的2型糖尿病与骨评分变化风险增加呈正相关（与没有2型糖尿病的受试者相比）。有序反应每个阈值处的累积比值比（COR）为11.4（95%CI = 2.5，53.3）。与血糖控制良好的2型糖尿病患者相比，PC组患者的COR为5.3（95%CI = 0.8，53.3）。与没有2型糖尿病的患者相比，血糖控制良好的2型糖尿病患者的COR为2.2（95%CI = 0.7，6.5）。这些结果表明，血糖控制较差会导致牙槽骨丧失风险增加，且骨质丧失进展比没有2型糖尿病的患者更严重，并且可能存在一个梯度，血糖控制较好的2型糖尿病患者骨质丧失进展风险介于其他两组之间。
