Marginal Structural Models for Periodontal Treatments effects on A1C in Diabetes

牙周治疗的边缘结构模型对糖尿病 A1C 的影响

• 批准号: 8636010
• 负责人: Anwar Merchant
• 金额: $ 12.5万
• 依托单位: DORN RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8636010
• 关键词: Academy; Adult; American; Antibiotic Therapy; Area; Calculi; Caring; Chronic; Clinic; Clinical Research; Clinical Trials; Cross-Sectional Studies; Data; Databases; Debridement; Defect; Diabetes Mellitus; Gingiva; Goals; Guidelines; Hemoglobin; Housing; Individual; Inflammatory; Informatics; Long-Term Effects; Maintenance; Medical center; Meta-Analysis; Mission; National Institute of Dental and Craniofacial Research; Non-Insulin-Dependent Diabetes Mellitus; Operative Surgical Procedures; Oral; Oral health; Patients; Periodontal Diseases; Periodontitis; Persons; Population; Prospective Studies; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Recurrence; Reporting; Research; Research Design; Research Infrastructure; Risk; Robin bird; Sample Size; Schedule; Secure; Statistical Methods; Structural Models; Systemic disease; Time; Tooth Loss; United States; United States Department of Veterans Affairs; Veterans; Visit; base; computerized; effective therapy; follow-up; glycemic control; improved; oral condition; population based; prevent; public health relevance; repaired; scaling and root planing; treatment effect; type I and type II diabetes

DESCRIPTION (provided by applicant): A1C is higher among individuals with diabetes mellitus (DM) when periodontal disease is present, and therefore treatment of chronic periodontitis is hypothesized to reduce A1C levels among individuals with DM. A meta-analysis of clinical trials showed that periodontal treatment reduced A1C by 0.4% at three months follow-up, however, these results are not definitive because the studies were heterogeneous, they had small sample sizes, and treatment was not always randomized. Moreover, the long term impact of periodontal treatment on A1C is unknown. Consequently periodontal treatment is currently not a recommended strategy to control A1C in DM. The American Academy of Periodontology (AAP) guidelines for effective treatment and control of chronic periodontitis consists of initial treatment followed by periodontal maintenance visits every 3 to 6 months. To the best of our knowledge the long-term strategy to treat and control periodontitis based on AAP guidelines has not been evaluated in relation to glycemic control among individuals with DM. We propose to evaluate the long-term effect (over 2 years) of AAP recommended treatment for chronic periodontitis on A1C among individuals with DM using data from the Veterans Administration computerized database in a prospective study design. To overcome the limitation of time-dependent confounding (periodontal maintenance visit determines subsequent periodontal treatment) we propose to use Marginal Structural Models (MSM) developed by Robins. This approach has, to our knowledge, not been previously used to assess oral-systemic disease relations. These analyses will therefore enhance the application of modern statistical methods to oral health research. The results from these analyses will approach those from a randomized controlled trial evaluating overall effect of long term periodontal care on A1C among individuals with DM. Controlling hemoglobin A1C in T2DM has been shown to prevent complications, yet just 44% of all Americans with DM have A1C within the recommended levels. A 1% reduction in A1C is associated with a 21% reduction for any diabetes-related endpoint among individuals with T2DM. If treatment of chronic periodontitis even modestly reduces A1C in individuals with DM, this will have important implications for the management of individuals with DM and periodontitis.

描述(申请人提供)：糖尿病(DM)患者在存在牙周疾病时A1C水平较高，因此治疗慢性牙周炎被认为可以降低DM患者的A1C水平。临床试验的荟萃分析显示，牙周治疗在三个月的随访中降低了0.4%的糖化血红蛋白，然而，这些结果并不是决定性的，因为这些研究是不同的，样本量小，治疗并不总是随机的。此外，牙周治疗对糖化血红蛋白的长期影响尚不清楚。因此，牙周治疗目前不是控制糖尿病患者糖化血红蛋白的推荐策略。美国牙周学学会(AAP)有效治疗和控制慢性牙周炎的指南包括每3至6个月进行一次初步治疗，然后进行牙周维护检查。就我们所知，根据AAP指南治疗和控制牙周炎的长期策略尚未被评估与糖尿病患者的血糖控制有关。我们建议在前瞻性研究设计中使用退伍军人管理局计算机化数据库中的数据来评估AAP推荐治疗慢性牙周炎对糖尿病患者的A1C的长期效果(超过2年)。为了克服依赖时间的混淆(牙周维护访问决定后续牙周治疗)的局限性，我们建议使用Robins开发的边缘结构模型(MSM)。据我们所知，这种方法以前从未被用来评估口腔-全身疾病之间的关系。因此，这些分析将加强现代统计方法在口腔健康研究中的应用。这些分析的结果将接近一项随机对照试验的结果，该试验评估了长期牙周护理对糖尿病患者糖化血红蛋白的总体影响。控制2型糖尿病患者的血红蛋白A1C已被证明可以预防并发症，然而，在所有美国糖尿病患者中，只有44%的A1C在推荐水平内。在2型糖尿病患者中，A1C降低1%与任何糖尿病相关终点减少21%相关。如果慢性牙周炎的治疗甚至适度降低糖尿病患者的A1C，这将对糖尿病和牙周炎患者的管理具有重要意义。

项目成果

Cross-sectional association of physical activity and periodontal antibodies.

• DOI: 10.1002/jper.17-0709
• 发表时间: 2018-12
• 期刊: JOURNAL OF PERIODONTOLOGY
• 影响因子: 4.3
• 作者: Anderson, A. Paige;Park, Yong-Moon;Shrestha, Deepika;Zhang, Jiajia;Liu, Jihong;Merchant, Anwar T.
• 通讯作者: Merchant, Anwar T.