A study on the establishment of periodontal treatment for patients with insulin resistant diabetes mellitus.

糖尿病患者的数量明显增加，这可能是由于我们生活方式的迅速改变，以及胰岛素抵抗的肥胖受试者的增加。脂肪组织中脂肪细胞产生的肿瘤坏死因子-α（TNF-α）影响肥胖患者的胰岛素抵抗。除脂肪细胞外，炎性病变中浸润的活化巨噬细胞也产生大量TNF-α。基于这些背景，我们假设糖尿病患者成功的牙周治疗可能导致循环TNF-α的降低和随后的糖尿病代谢控制。结果表明，抗菌牙周治疗导致1）牙周袋中微生物数量和2）循环TNF-α浓度显著降低，我们还发现一些牙周炎患者表现出抗GAD抗体的增加，该抗体被广泛用作1型糖尿病患者的血清学诊断标志物。通常，已知GAD在胰腺β细胞和一些神经细胞中产生。然而，我们也发现成纤维细胞，包括牙龈成纤维细胞表达GAD在基因和蛋白水平。因此，我们认为，牙周炎症破坏牙周结缔组织导致GAD的释放，并将这种GAD暴露于免疫细胞，导致抗GAD抗体的产生。因此，牙周炎症可能影响1型糖尿病的血清学诊断，提示糖尿病不仅影响牙周炎的易感性和进展，牙周炎症也影响糖尿病的病情。因此，可以得出结论，牙周炎是糖尿病的重要并发症，调节糖尿病的临床过程和诊断程序。

The number of diabetes increased markedly due possibly to the rapid change of our lifestyle, and to the increase in obese subjects with insulin resistance. Tumor necrosis factor-α (TNF-α) produced from adipocytes in the adipose tissues has been suggested to be affect insulin resistance in obese subjects. Apart from adipocytes, activated macrophages infiltrated in inflammatory lesion also produce large quantity of TNF-α. Based on these backgrounds, we hypothesized that successful periodontal treatment in diabetes patients may result in decrease in circulating TNF-α and subsequent metabolic control of diabetes. The results indicated that anti-microbial periodontal treatment resulted in marked decrease in 1) the number of microorganism in periodontal pockets and 2) circulating TNF-α concentration, and in significant improvement in 3) insulin resistance and 4) subsequent metabolic control.We also found that some periodontitis patients exhibited increased anti-GAD antibody which is widely used as a sero-diagnostic marker in patients with type 1 diabetes. Generally, GAD is known to be produced in pancreatic β-cells and some nerve cells. However, we also found that fibroblastic cells including gingival fibroblasts express GAD both at gene and protein level. Thus, we thought that periodontal inflammation which destruct periodontal connective tissues resulted in the release of GAD and in exposure of such GAD to immune cells, led to the production of anti-GAD antibodies. Therefore, it is possible that periodontal inflammation influences sero-diagnosis of type 1 diabetes.These results indicate that diabetes not only influence the susceptibility and progression of periodontitis, but periodontal inflammation also influences diabetic status. Thus, it can be concluded that periodontitis is an important complication of diabetes modulating the clinical course and diagnostic procedure of diabetes.