Periodontitis and pre-clinical diabetes

牙周炎和临床前糖尿病

• 批准号: 8269552
• 负责人: KAUMUDI J JOSHIPURA
• 金额: $ 40万
• 依托单位: UNIVERSITY OF PUERTO RICO MED SCIENCES
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-15 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8269552
• 关键词: Adult; Age-Years; Blood; Blood Pressure; Body mass index; C-reactive protein; Clinical; Complex; Dental; Diabetes Mellitus; Disease Resistance; Dyslipidemias; Fasting; Fatty acid glycerol esters; Glucose; Glucose Intolerance; Goals; Healthcare; High Density Lipoprotein Cholesterol; High Prevalence; Hour; Hypertriglyceridemia; Incidence; Individual; Insulin Resistance; Interleukin-6; Interview; Longitudinal Studies; Low income; Measurement; Measures; Mediating; Minority; Morbidity - disease rate; Municipalities; Non-Insulin-Dependent Diabetes Mellitus; OGTT; Obesity; Oral; Overweight; Participant; Pathway interactions; Periodontal Diseases; Periodontitis; Play; Population; Prevention; Public Health; Puerto Rican; Puerto Rico; Recruitment Activity; Risk Factors; Staging; Time; Tumor Necrosis Factor-alpha; Visit; adipokines; adiponectin; blood glucose regulation; cohort; design; follow-up; glucose tolerance; high risk; improved; inflammatory marker; modifiable risk; mortality; oral glucose tolerance; pre-clinical; prevent; public health relevance; waist circumference

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.

描述(由申请人提供)：几项研究表明牙周病和2型糖尿病之间存在联系，但从纵向研究中获得的证据很少。因此，这些关系是复杂的，目前尚不清楚牙周病是糖尿病的原因还是后果，还是两者兼而有之，建立时间序列是重要的。作为明确建立时间序列的第一步，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疾病进展的影响。这项研究在建立没有糖尿病的超重和肥胖者队列方面是独一无二的。这一独特的人群将构成高危人群，因为高水平的牙周病和胰岛素抵抗，以及预期更高的进展率使有效的设计成为可能。具体目标是：(1)评估基线水平的牙周病患者与非牙周病患者相比，是否有更高的葡萄糖耐量和胰岛素抵抗增加；(2)确定基线牙周病与糖耐量增加和胰岛素抵抗之间的纵向关联是否通过脂肪因子、血脂异常和/或炎症标记物，包括C反应蛋白、肿瘤坏死因子和白介素6；(3)评估基线血糖异常和胰岛素抵抗是否与三年期间牙周病的进展有关；(4)评估肥胖指标(包括体重指数、腰围和基线时的脂肪质量)与牙周病的线性关系。我们计划纳入40-65岁的超重或肥胖成年人的高危群体，他们没有糖尿病，也没有排除从圣胡安市招募的牙周检查的条件。参与者将在基线和基线考试三年后进行评估。基线和随访将包括空腹采血和2小时口服葡萄糖耐量试验、血压评估、牙科检查、面谈和人体测量。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。长期目标将是继续跟踪评估牙周病是否是葡萄糖不耐受和/或胰岛素抵抗参与者中发生2型糖尿病的风险因素。鉴于牙周病和2型糖尿病的高患病率，这项研究具有非常重要的意义，因为牙周病可能是2型糖尿病的一个可改变的危险因素。 公共卫生相关性： 鉴于牙周病和胰岛素抵抗的高患病率，这项研究将在确定牙周病是否可能成为胰岛素抵抗的可改变的危险因素方面发挥关键作用，这可能对预防2型糖尿病具有意义。预防糖尿病或牙周病的措施或改善血糖稳态的措施对于减少发病率和死亡率以及减少糖尿病日益严重的医疗保健差距问题至关重要，特别是在少数民族、低收入和服务不足的成年人中。