Periodontitis and pre-clinical diabetes

描述（由申请人提供）：一些研究表明牙周病和2型糖尿病之间存在关联，但很少有来自纵向研究的证据。因此，两者之间的关系是复杂的，目前尚不清楚牙周病是糖尿病的原因还是结果，或者两者兼而有之，建立时间序列是很重要的。作为明确时间序列的第一步，本研究重点评估牙周病对糖尿病临床前阶段进展的影响，以及糖尿病临床前阶段对牙周病进展的影响。这项研究的独特之处在于建立了一个没有糖尿病的超重和肥胖个体队列。由于牙周病和胰岛素抵抗的高水平和预期的更高的进展率，这一独特的人群将构成一个高风险群体，从而使有效的设计成为可能。具体目的是：(1)评估在三年的时间里，与没有牙周病的人相比，有牙周病的人是否有更高的葡萄糖不耐受和胰岛素抵抗的增加；(2)确定牙周病基线与葡萄糖耐量和胰岛素抵抗升高之间的纵向关联是否通过脂肪因子、血脂异常和/或炎症标志物介导，包括C反应蛋白、肿瘤坏死因子和白细胞介素6；(3)评估基线血糖异常和胰岛素抵抗是否与牙周病三年的进展相关；(4)评估肥胖指标（包括体重指数、腰围和基线脂肪量）与牙周病之间的线性关系。我们计划从圣胡安市招募一组超重或肥胖的高危人群，年龄在40-65岁之间，没有糖尿病，也没有无法进行牙周检查的条件。参与者将在基线和基线考试后的三年内进行评估。基线和随访将包括空腹抽血和2小时口服葡萄糖耐量试验、血压评估、牙科检查、访谈和人体测量测量。我们将评估临床牙周测量与三年内口服葡萄糖耐量和胰岛素抵抗变化之间的纵向关系。我们还将评估基线人体测量、口服葡萄糖和胰岛素抵抗与牙周病进展的关系。长期目标将是继续随访，以评估牙周病是否是糖耐受不良和/或胰岛素抵抗参与者中2型糖尿病发病率的危险因素。鉴于牙周病和2型糖尿病的高患病率，这项研究具有高度意义，因为牙周病可能是2型糖尿病的可改变危险因素。

DESCRIPTION (provided by applicant): Several studies have shown associations between periodontal disease and type 2 diabetes, but very little evidence is available from longitudinal studies. Hence, the relationships are complex and it is unclear whether periodontal disease is a cause or consequence of diabetes or both and it is important to establish the temporal sequence. As a first step to clearly establish the time sequence, this study focuses on assessing the impact of periodontal disease on the progression of preclinical stages of diabetes and the impact of preclinical stages of diabetes on progression of periodontal disease. This study is unique in establishing a cohort of overweight and obese individuals free of diabetes. This unique population will constitute a high risk group because of the high levels of periodontal disease and insulin resistance and expected higher rates of progression enabling an efficient design. The specific aims are: (1) to assess whether, over a three-year period, individuals with periodontal disease at baseline have a higher increase in glucose intolerance and insulin resistance compared to those without periodontal disease; (2) to determine if the longitudinal association between baseline periodontal disease and increases in glucose tolerance and insulin resistance is mediated through adipokines, dyslipidemia and/or inflammatory markers, including C reactive protein, tumor necrosis factor , and interleukin 6; (3) to assess whether baseline glucose abnormalities and insulin resistance are associated with progression of periodontal disease over a three-year interval; and (4) to assess the linear association between adiposity measures including body mass index, waist circumference and fat mass at baseline and periodontal disease. We plan to include a high-risk group of overweight or obese adults, 40-65 years of age, free of diabetes and of conditions that preclude a periodontal exam recruited from the San Juan municipality. Participants will be assessed at baseline and three years after the baseline exam. The baseline and follow-up visits will include blood drawing at fasting and 2 hour oral glucose tolerance test, blood pressure assessment, dental examinations, interviews and anthropometrics measures. We will evaluate the longitudinal relationship between clinical periodontal measures and changes over a three-year time period in oral glucose tolerance and insulin resistance. We will also assess the relationship of baseline anthropometric measurements, oral glucose and insulin resistance with the progression of periodontal disease. The long-term goals will be to continue follow-up to assess whether periodontal disease is a risk factor for the incidence of type 2 diabetes among participants with glucose intolerance and/or insulin resistance. Given the high prevalence of periodontal disease and type 2 diabetes, this study is highly significant as periodontal disease could be a modifiable risk factor for type 2 diabetes. PUBLIC HEALTH RELEVANCE: Given the high prevalence of periodontal disease and insulin resistance, this study will play a key role in determining whether periodontal disease could potentially be a modifiable risk factor for insulin resistance which could have implications in the prevention of type 2 diabetes. Measures that prevent diabetes or periodontal disease or measures that improve glucose homeostasis are central to reducing morbidity and mortality as well as to reducing the growing problem of health care disparities for diabetes, especially among minority, low-income, and underserved adult populations.