Lancet子刊:牙周炎治疗可帮助2型糖尿病患者降血糖

选取264名患有中重度牙周炎的2型糖尿病患者随机分为2组,分别接受强化牙周炎治疗(IPT,n=133)及普通牙周炎治疗(CPT,n=131),治疗12个月;
校正基础糖化血红蛋白(Hb1Ac)、年龄、性别、种族、吸烟状态、BMI、糖尿病发病时长后,IPT组患者的Hb1Ac比CPT组患者低0.6%,且具有统计学显著性差异;
IPT组及CPT组中各有11例严重不良事件发生,分别包括1例及3例死亡病例。
延伸阅读

Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial

牙周炎治疗在2型糖尿病患者中的系统性效应:一项为期12个月的单中心单盲随机临床试验

2018-10-24, Article, 10.1016/S2213-8587(18)30038-Xmore

Abstract:
Background: Chronic inflammation is believed to be a major mechanism underlying the pathophysiology of type 2 diabetes. Periodontitis is a cause of systemic inflammation. We aimed to assess the effects of periodontal treatment on glycaemic control in people with type 2 diabetes.
Methods: In this 12 month, single-centre, parallel-group, investigator-masked, randomised trial, we recruited patients with type 2 diabetes, moderate-to-severe periodontitis, and at least 15 teeth from four local hospitals and 15 medical or dental practices in the UK. We randomly assigned patients (1:1) using a computer-generated table to receive intensive periodontal treatment (IPT; whole mouth subgingival scaling, surgical periodontal therapy [if the participants showed good oral hygiene practice; otherwise dental cleaning again], and supportive periodontal therapy every 3 months until completion of the study) or control periodontal treatment (CPT; supra-gingival scaling and polishing at the same timepoints as in the IPT group). Treatment allocation included a process of minimisation in terms of diabetes onset, smoking status, sex, and periodontitis severity. Allocation to treatment was concealed in an opaque envelope and revealed to the clinician on the day of first treatment. With the exception of dental staff who performed the treatment and clinical examinations, all study investigators were masked to group allocation. The primary outcome was between-group difference in HbA 1c at 12 months in the intention-to-treat population. This study is registered with the ISRCTN registry, number ISRCTN83229304.
Findings: Between Oct 1, 2008, and Oct 31, 2012, we randomly assigned 264 patients to IPT (n=133) or CPT (n=131), all of whom were included in the intention-to-treat population. At baseline, mean HbA 1c was 8·1% (SD 1·7) in both groups. After 12 months, unadjusted mean HbA 1c was 8·3% (SE 0·2) in the CPT group and 7·8% (0·2) in the IPT group; with adjustment for baseline HbA 1c, age, sex, ethnicity, smoking status, duration of diabetes, and BMI, HbA 1c was 0·6% (95% CI 0·3–0·9; p<0·0001) lower in the IPT group than in the CPT group. At least one adverse event was reported in 30 (23%) of 133 patients in the IPT group and 23 (18%) of 131 patients in the CPT group. Serious adverse events were reported in 11 (8%) patients in the IPT group, including one (1%) death, and 11 (8%) patients in the CPT group, including three (2%) deaths.
Interpretation: Compared with CPT, IPT reduced HbA 1c in patients with type 2 diabetes and moderate-to-severe periodontitis after 12 months. These results suggest that routine oral health assessment and treatment of periodontitis could be important for effective management of type 2 diabetes.

First Authors:
Nikos Donos,John E Deanfield

Correspondence Authors:
Francesco D'Aiuto

All Authors:
Francesco D'Aiuto,Nikolaos Gkranias,Devina Bhowruth,Tauseef Khan,Marco Orlandi,Jean Suvan,Stefano Masi,Georgios Tsakos,Steve Hurel,Aroon D Hingorani,Nikos Donos,John E Deanfield