今回は2型糖尿病患者に非外科的歯周治療を行い

HbA1cが改善するかどうか検討しています。

アメリカの５ヵ所のメディカルセンターにて

2型糖尿病を有する歯周病患者514名を対象とし

テスト群には全顎的なSRP＋0.12%クロルヘキシジン

を行っています。

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 nonsurgical periodontal treatment reduces levels of glycated hemoglobin (HbA1c) in persons with type 2 diabetes and moderate to advanced chronic periodontitis.

The Diabetes and Periodontal Therapy Trial (DPTT), a 6-month, single-masked, multicenter, randomized clinical trial. Participants had type 2 diabetes, were taking stable doses of medications, had HbA1c levels between 7% and less than 9%, and untreated chronic periodontitis. Five hundred fourteen participants were enrolled between November 2009 and March 2012 from diabetes and dental clinics and communities affiliated with 5 academic medical centers.

The treatment group (n = 257) received scaling and root planing plus chlorhexidine oral rinse at baseline and supportive periodontal therapy at 3 and 6 months. The control group (n = 257) received no treatment for 6 months.

Difference in change in HbA1c level from baseline between groups at 6 months. Secondary outcomes included changes in probing pocket depths, clinical attachment loss, bleeding on probing, gingival index, fasting glucose level, and Homeostasis Model Assessment (HOMA2) score.

Enrollment was stopped early because of futility. At 6 months, mean HbA1c levels in the periodontal therapy group increased 0.17% (SD, 1.0), compared with 0.11% (SD, 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% CI, -0.23% to 0.12%]; P = .55). Periodontal measures improved in the treatment group compared with the control group at 6 months, with adjusted between-group differences of 0.28 mm (95% CI, 0.18 to 0.37) for probing depth, 0.25 mm (95% CI, 0.14 to 0.36) for clinical attachment loss, 13.1% (95% CI, 8.1% to 18.1%) for bleeding on probing, and 0.27 (95% CI, 0.17 to 0.37) for gingival index (P < .001 for all).

Nonsurgical periodontal therapy did not improve glycemic control in patients with type 2 diabetes 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 levels of HbA1c.

結果は6ヶ月後PPDは平均0.4mmの有意な改善を認め

BOPは19%減少したがHbA1cは減少しなかった。

結論として2型糖尿病患者に非外科的歯周治療を行ったが

術前述後でHbA1cは変化しなかった

ということです。

.

引用文献

Engebretson SP¹, Hyman LG², Michalowicz BS³, Schoenfeld ER², Gelato MC², Hou W², Seaquist ER⁴, Reddy MS⁵, Lewis CE⁶, Oates TW⁷, Tripathy D⁸, Katancik JA⁹, Orlander PR¹⁰, Paquette DW¹¹, Hanson NQ¹², Tsai MY¹².

The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial.

JAMA. 2013 Dec 18;310(23):2523-32.