改善口腔卫生,或能降低糖尿病风险?
  • 纳入188013名韩国受试者,其中17.5%患有牙周病,中位随访10年后,31545名受试者发生糖尿病,事件发生率为16.1%;
  • 在多变量模型中,校正人口统计、生活习惯和基础疾病史后发现牙周病和缺牙数量(≥15颗)与新发糖尿病发生率呈正相关;
  • 口腔卫生不佳导致溃疡和牙齿松动,致病菌和毒性因子或因此进入人体循环系统导致糖尿病;
  • 经常刷牙(≥3次/天)与新发糖尿病发生率呈负相关,因此改善口腔卫生或可降低新发糖尿病的发生风险。
主编推荐语
潇洒小姐陈
Diabetologia的这篇文章探究了牙周病和新发糖尿病的关系。目前针对新发糖尿病的药物和干预疗法较少,多为基于健康生活方式的预防性措施。牙周病不仅可导致牙齿周围组织的炎症,也可导致全身炎症,并已被证明与心血管疾病相关。作者由此进行了全国性(韩国)回顾性队列研究,发现口腔卫生和牙周病与新发糖尿病正相关,而多刷牙与新发糖尿病负相关。本研究的不足之处包括:研究仅限韩国人,研究方式为问卷调查,牙周病严重程度未知,结果搜集时间较长,牙齿缺失原因未知,未区分1型和2型糖尿病和参与者社会地位和经济实力等未考虑在内。多刷牙保持牙齿健康是好事,但是否真的可以减少个人糖尿病发病风险还需进一步验证。
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Diabetologia [IF:10.46]

Improved oral hygiene is associated with decreased risk of new-onset diabetes: a nationwide population-based cohort study

改善口腔卫生与新发糖尿病风险降低相关:一项基于韩国人群的全国性队列研究

10.1007/s00125-020-05112-9

2020-03-02, Article

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Aims/hypothesis: Inflammation plays an important role in the development of diabetes, a major global health problem. Periodontal disease is also common in the general population. Because periodontal disease and poor oral hygiene can provoke transient bacteraemia and systemic inflammation, we hypothesised that periodontal disease and oral hygiene indicators would be associated with the occurrence of new-onset diabetes.
Methods: In this study we analysed data collected between 2003 and 2006 on 188,013 subjects from the National Health Insurance System-Health Screening Cohort (NHIS-HEALS) in Korea who had no missing data for demographics, past medical history, oral hygiene indicators or laboratory findings. The presence of periodontal disease was defined on the basis of a modified version of ICD-10 codes (Korean Classification of Disease, sixth edition), if claims for treatment for acute periodontitis (K052), chronic periodontitis (K053) and periodontosis (K054) were made more than two times by a dentist, or if, according to medical records, subjects received treatment by a dentist for periodontal disease with ICD-10 codes K052, K053 or K054. Oral hygiene behaviours (number of tooth brushings, a dental visit for any reason and professional dental cleaning) were collected as self-reported data of dental health check-ups. Number of missing teeth was ascertained by dentists during oral health examination. The incidence of new-onset diabetes was defined according to ICD-10 codes E10–E14. The criterial included at least one claim per year for both visiting an outpatient clinic and admission accompanying prescription records for any glucose-lowering agent, or was based on a fasting plasma glucose ≥7 mmol/l from NHIS-HEALS.
Results: Of the included subjects, 17.5% had periodontal disease. After a median follow-up of 10.0 years, diabetes developed in 31,545 (event rate: 16.1%, 95% CI 15.9%, 16.3%) subjects. In multivariable models, after adjusting for demographics, regular exercise, alcohol consumption, smoking status, vascular risk factors, history of malignancy and laboratory findings, the presence of periodontal disease (HR 1.09, 95% CI 1.07, 1.12, p < 0.001) and number of missing teeth (≥15 teeth) remained positively associated with occurrence of new-onset diabetes (HR 1.21, 95% CI 1.09, 1.33, p < 0.001, p for trend <0.001). Frequent tooth brushing (≥3 times/day) was negatively associated with occurrence of new-onset diabetes (HR 0.92, 95% CI 0.89, 0.95, p < 0.001, p for trend <0.001).
Conclusions/interpretation: Frequent tooth brushing may be an attenuating factor and the presence of periodontal disease and an increased number of missing teeth may be augmenting factors for the occurrence of new-onset diabetes. Improving oral hygiene may be associated with a decreased risk of occurrence of new-onset diabetes.

First Authors:
Yoonkyung Chang

Correspondence Authors:
Tae-Jin Song

All Authors:
Yoonkyung Chang,Ji Sung Lee,Ki-Jung Lee,Ho Geol Woo,Tae-Jin Song

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