The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial.
The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial.
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DOI：
10.1001/jama.2013.282431
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发表时间：
2013-12-18
影响因子：
120.7
通讯作者：
Tsai, Michael Y.
中科院分区：
文献类型：
--
作者：
Engebretson, Steven P.;Hyman, Leslie G.;Michalowicz, Bryan S.;Schoenfeld, Elinor R.;Gelato, Marie C.;Hou, Wei;Seaquist, Elizabeth R.;Reddy, Michael S.;Lewis, Cora E.;Oates, Thomas W.;Tripathy, Devjit;Katancik, James A.;Orlander, Philip R.;Paquette, David W.;Hanson, Naomi Q.;Tsai, Michael Y.
慢性牙周炎是一种破坏牙齿支撑结构的炎症性疾病，在糖尿病患者中很常见。有限的证据表明，牙周治疗可以改善血糖控制。确定非手术牙周治疗是否降低2型糖尿病（DM）和中晚期慢性牙周炎患者的血红蛋白A1 c（HbA 1c）。糖尿病和牙周病治疗试验（DPTT）是一项为期6个月、单盲、随机、多中心的临床试验。参与者患有糖尿病，正在服用稳定剂量的药物，HbA 1c ≥7%且<9%，牙周炎未经治疗。2009年11月至2012年3月期间，从糖尿病和牙科诊所以及隶属于五个学术医疗中心的社区招募了514名参与者。治疗组（n=257）在基线时接受洁治和根面平整术联合洗必泰漱口液治疗，并在3个月和6个月时进行牙周支持治疗。对照组（n=257）6个月不接受任何治疗。6个月时两组间HbA 1c较基线变化的差异。次要结局包括探诊囊袋深度的变化、临床附着丧失、探诊出血、牙龈指数、空腹血糖和稳态模型评估（HOMA 2）。由于无效，提前停止入组。6个月时，牙周治疗组HbA 1c增加0.17%（1.0）（平均值（SD）），而对照组为0.11%（1.0），基于针对临床部位调整的线性回归模型，两组之间无显著差异（平均差异= -0.05%; 95%置信区间（CI）：-0.23%，0.12%; p=0.55）。与对照组相比，治疗组在6个月时的探诊深度、临床附着丧失、探诊出血和牙龈指数指标均有所改善，校正后的组间差异为0.33 mm（95% CI：0.26，0.39）、0.31 mm（95% CI：0.23，0.39）、16.5%（95% CI：12.9，20.0）和0.28（95% CI：0.21，0.35）;所有p值<0.0001）。非手术牙周治疗不能改善糖尿病和中晚期慢性牙周炎患者的血糖控制。这些发现不支持糖尿病患者使用非手术牙周治疗来降低HbA 1c。
Chronic periodontitis, a destructive inflammatory disorder of the supporting structures of the teeth, is prevalent in patients with diabetes. Limited evidence suggests that periodontal therapy may improve glycemic control. To determine if non-surgical periodontal treatment reduces hemoglobin A1c (HbA1c) in persons with type 2 diabetes (DM) and moderate to advanced chronic periodontitis. The Diabetes and Periodontal Therapy Trial (DPTT) is a 6-month, single-masked, randomized, multi-center clinical trial. Participants had DM, were taking stable doses of medications, had HbA1c ≥7% and <9%, and untreated periodontitis. Five hundred fourteen participants were enrolled between November 2009 and March 2012 from diabetes and dental clinics and communities affiliated with five academic medical centers. The treatment group (n=257) received scaling and root planing plus chlorhexidine oral rinse at baseline, and supportive periodontal therapy at three and six months. The control group (n=257) received no treatment for six months. Difference in HbA1c change from baseline between groups at six months. Secondary outcomes included changes in probing pocket depths, clinical attachment loss, bleeding on probing, gingival index, fasting glucose, and the Homeostasis Model Assessment (HOMA2). Enrollment was stopped early due to futility. At 6 months, the periodontal therapy group increased HbA1c 0.17% (1.0) (mean (SD)) compared to 0.11% (1.0) in the control group, with no significant difference between groups based on a linear regression model adjusting for clinical site (mean difference = -0.05%; 95% Confidence Interval (CI): -0.23%, 0.12%; p=0.55). Probing depth, clinical attachment loss, bleeding on probing and gingival index measures improved in the treatment group compared to the control group at six months with adjusted between-group differences of 0.33mm (95% CI: 0.26, 0.39), 0.31mm (95% CI: 0.23, 0.39), 16.5% (95% CI: 12.9, 20.0) and 0.28 (95% CI: 0.21, 0.35), respectively; all p values <0.0001). Non-surgical periodontal therapy did not improve glycemic control in patients with DM and moderate to advanced chronic periodontitis. These findings do not support the use of nonsurgical periodontal treatment in patients with diabetes for the purpose of lowering HbA1c.
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影响因子：
1.9
作者：
LAN, KKG;WITTES, J
通讯作者：
WITTES, J
影响因子：
15.8
作者：
Ioannidis, JPA
通讯作者：
Ioannidis, JPA
DOI：
10.14219/jada.archive.1993.0247
发表时间：
1993-12-01
影响因子：
3.9
作者：
OLIVER, RC;TERVONEN, T
通讯作者：
TERVONEN, T
影响因子：
39.2
作者：
Goldfine AB;Fonseca V;Jablonski KA;Pyle L;Staten MA;Shoelson SE;TINSAL-T2D (Targeting Inflammation Using Salsalate in Type 2 Diabetes) Study Team
通讯作者：
TINSAL-T2D (Targeting Inflammation Using Salsalate in Type 2 Diabetes) Study Team
影响因子：
4.3
作者：
HIRSCHFELD, L;WASSERMAN, B
通讯作者：
WASSERMAN, B