Effect of non-surgical periodontal therapy on insulin resistance and insulin sensitivity among individuals with borderline diabetes: A randomized controlled trial
Effect of non-surgical periodontal therapy on insulin resistance and insulin sensitivity among individuals with borderline diabetes: A randomized controlled trial
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DOI：
10.1016/j.jdent.2019.04.005
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发表时间：
2019-06-01
影响因子：
4.4
通讯作者：
Saito, Isao
中科院分区：
文献类型：
--
作者：
Nishioka, Shinji;Maruyama, Koutatsu;Saito, Isao
目的：探讨非手术牙周治疗对未接受药物治疗的临界性糖尿病患者胰岛素抵抗和胰岛素敏感性的影响。方法：对75 g口服葡萄糖耐量试验确诊的临界性糖尿病患者进行交叉随机对照试验。参与者被随机分配到早期干预组或后期干预组。早期干预组在前6个月进行非手术牙周治疗，然后进行6个月的非干预期。在后来的干预组中，顺序颠倒了。主要结果包括：空腹或负荷后血糖和胰岛素、体重指数(BMI)、HOMA-IR、HOMA-β和松田指数。结果：74名参与者被随机分配，71名参与者完成试验。在干预和非干预期间，两组之间的血糖和胰岛素浓度没有显著差异。根据干预前探诊出血(BOP)水平在组内进行分析，低BOP组的BMI、HOMA-IR、HOMA-β和松田指数的变化有所改善(P<；0.05)。此外，我们观察到基线BOP与BMI变化呈正相关(P=0.06)。体重指数的变化与糖化血红蛋白、胰岛素抵抗指数和胰岛素抵抗指数的变化呈正相关，与松田指数的变化呈负相关(P=0.001)。结论：牙周治疗对临界性糖尿病患者的胰岛素和糖代谢相关指标无明显影响。然而，BOP(%)较低的参与者在BMI、空腹血清胰岛素、HOMA-IR、HOMA-β和松田指数方面有显著改善。临床意义：在诊断为临界性糖尿病的患者中，那些BOP(%)低于37%的人在非手术牙周治疗后显示出BMI、空腹血清胰岛素、HOMA-IR、HOMA-β和松田指数的潜在改善。
Objective: To investigate the effect of non-surgical periodontal therapy on insulin resistance and sensitivity among individuals with borderline diabetes not receiving medications.Methods: A crossover, randomized controlled trial was conducted among participants with borderline diabetes diagnosed by a 75-g oral glucose tolerance test. Participants were randomly assigned to either an early or later intervention group. The early intervention group underwent non-surgical periodontal therapy of scaling and root planing during the first 6 months, followed by a 6-month non-intervention period. The order was reversed in the later intervention group. Primary outcomes included: fasting or post-load serum glucose and insulin, body mass index (BMI), HOMA-IR, HOMA-beta, and Matsuda Index.Results: Seventy-four participants were randomized, and 71 participants completed the trial. There were no significant differences between groups in glucose and insulin concentrations during the intervention and non-intervention periods. When analyzed within groups by median-split of bleeding on probing (BOP) levels before intervention, the lower BOP group showed improved changes in BMI, HOMA-IR, HOMA-beta, and Matsuda Index (P < 0.05). Further, we observed a positive correlation between baseline BOP and change in BMI (P = 0.06). Change in BMI was positively correlated with changes in HbA(lc), HOMA-IR, and HOMA-beta (P < 0.05), and inversely correlated with change in Matsuda Index (P = 0.001).Conclusions: Periodontal therapy had no significant effect on markers related to insulin and glucose metabolism among individuals with borderline diabetes. However, participants with a lower BOP (%) showed significant improvements in BMI, fasting serum insulin, HOMA-IR, HOMA-beta and Matsuda Index.Clinical significance: Among individuals diagnosed with borderline diabetes, those who had < 37% of a lower BOP (%) showed potential improvements in BMI, fasting serum insulin, HOMA-IR, HOMA-beta and Matsuda Index following non-surgical periodontal therapy.