F V Bitencourt, A Andersen, L Bjerg, A Sandbæk, H Li, G G Nascimento, R Spin-Neto, M A Peres, F R M Leite
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Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for individual and joint microvascular diabetes complications. The models adjusted for potential confounders, including sociodemographic factors, lifestyle behaviors, and health conditions. Inverse probability of treatment weighting (IPTW) balanced measured confounders between periodontitis and nonperiodontitis participants. Sensitivity analyses tested the findings' robustness by estimating E-values for unmeasured confounding and varying microvascular complication definitions. After IPTW, adjusted models revealed that diabetic neuropathy (OR 1.36, 95% CI 1.14 to 1.63) and retinopathy (OR 1.21, 95% CI 1.03 to 1.43) were significantly associated with moderate/severe periodontitis. Moreover, the coexistence of microvascular complications increased the odds 1.5-fold for moderate/severe periodontitis (OR 1.51, 95% CI 1.23 to 1.85). An effect modification of dyslipidemia on an additive scale was found, indicated by a positive relative excess risk due to interaction of 0.24 for neuropathy, 0.11 for retinopathy, and 0.44 for both complications. Sensitivity analysis ruled out unmeasured confounders and microvascular complication definitions as explanatory factors. Diabetic neuropathy and retinopathy, individually and combined, were associated with moderate/severe periodontitis. In addition, dyslipidemia had an additive positive effect modification on diabetic microvascular complications, elevating the odds of moderate/severe periodontitis. These findings may aid in identifying at-risk subgroups for diabetes-related microvascular complications and periodontitis, optimizing efforts to mitigate disease burden.</p>","PeriodicalId":94075,"journal":{"name":"Journal of dental research","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Periodontitis and Diabetes Complications: A Danish Population-Based Study.\",\"authors\":\"F V Bitencourt, A Andersen, L Bjerg, A Sandbæk, H Li, G G Nascimento, R Spin-Neto, M A Peres, F R M Leite\",\"doi\":\"10.1177/00220345241259954\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Conflicting evidence suggests a link between diabetes-related microvascular complications and periodontitis. Reliable estimates have been hindered by small sample sizes and residual confounding. Moreover, the combined effects of microvascular complications and dyslipidemia on periodontitis have not been explored. Therefore, this study aimed to investigate the association between individual and combined diabetic microvascular complications (i.e., neuropathy and retinopathy) and moderate/severe periodontitis in a Danish population-based study. In addition, we assessed whether dyslipidemia modified these associations. This study comprised 15,922 participants with type 2 diabetes from the Health in Central Denmark study. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for individual and joint microvascular diabetes complications. The models adjusted for potential confounders, including sociodemographic factors, lifestyle behaviors, and health conditions. Inverse probability of treatment weighting (IPTW) balanced measured confounders between periodontitis and nonperiodontitis participants. Sensitivity analyses tested the findings' robustness by estimating E-values for unmeasured confounding and varying microvascular complication definitions. After IPTW, adjusted models revealed that diabetic neuropathy (OR 1.36, 95% CI 1.14 to 1.63) and retinopathy (OR 1.21, 95% CI 1.03 to 1.43) were significantly associated with moderate/severe periodontitis. Moreover, the coexistence of microvascular complications increased the odds 1.5-fold for moderate/severe periodontitis (OR 1.51, 95% CI 1.23 to 1.85). An effect modification of dyslipidemia on an additive scale was found, indicated by a positive relative excess risk due to interaction of 0.24 for neuropathy, 0.11 for retinopathy, and 0.44 for both complications. Sensitivity analysis ruled out unmeasured confounders and microvascular complication definitions as explanatory factors. Diabetic neuropathy and retinopathy, individually and combined, were associated with moderate/severe periodontitis. In addition, dyslipidemia had an additive positive effect modification on diabetic microvascular complications, elevating the odds of moderate/severe periodontitis. 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引用次数: 0
摘要
相互矛盾的证据表明,糖尿病相关微血管并发症与牙周炎之间存在联系。由于样本量小和残余混杂因素,可靠的估计结果受到阻碍。此外,尚未探讨微血管并发症和血脂异常对牙周炎的综合影响。因此,本研究旨在通过一项基于丹麦人群的研究,探讨糖尿病微血管并发症(即神经病变和视网膜病变)与中度/重度牙周炎之间的关联。此外,我们还评估了血脂异常是否会改变这些关联。这项研究包括丹麦中部健康研究中的 15,922 名 2 型糖尿病患者。我们采用多叉逻辑回归法估算了单个和联合微血管糖尿病并发症的几率比(OR)和 95% 置信区间(CI)。模型调整了潜在的混杂因素,包括社会人口因素、生活方式行为和健康状况。反向治疗概率加权(IPTW)平衡了牙周炎和非牙周炎参与者之间的测量混杂因素。敏感性分析通过估算未测量混杂因素的 E 值和不同的微血管并发症定义来检验研究结果的稳健性。IPTW调整后的模型显示,糖尿病神经病变(OR 1.36,95% CI 1.14-1.63)和视网膜病变(OR 1.21,95% CI 1.03-1.43)与中度/重度牙周炎显著相关。此外,同时存在微血管并发症会使中度/重度牙周炎的几率增加 1.5 倍(OR 1.51,95% CI 1.23 至 1.85)。研究还发现,血脂异常对并发症的影响具有叠加效应,神经病变、视网膜病变和两种并发症的交互作用导致的正向相对超额风险分别为 0.24、0.11 和 0.44。敏感性分析排除了作为解释因素的未测量混杂因素和微血管并发症定义。糖尿病神经病变和视网膜病变单独或合并与中度/重度牙周炎有关。此外,血脂异常对糖尿病微血管并发症也有叠加的积极影响,提高了中度/重度牙周炎的几率。这些发现有助于确定糖尿病相关微血管并发症和牙周炎的高危亚群,从而优化减轻疾病负担的工作。
Periodontitis and Diabetes Complications: A Danish Population-Based Study.
Conflicting evidence suggests a link between diabetes-related microvascular complications and periodontitis. Reliable estimates have been hindered by small sample sizes and residual confounding. Moreover, the combined effects of microvascular complications and dyslipidemia on periodontitis have not been explored. Therefore, this study aimed to investigate the association between individual and combined diabetic microvascular complications (i.e., neuropathy and retinopathy) and moderate/severe periodontitis in a Danish population-based study. In addition, we assessed whether dyslipidemia modified these associations. This study comprised 15,922 participants with type 2 diabetes from the Health in Central Denmark study. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for individual and joint microvascular diabetes complications. The models adjusted for potential confounders, including sociodemographic factors, lifestyle behaviors, and health conditions. Inverse probability of treatment weighting (IPTW) balanced measured confounders between periodontitis and nonperiodontitis participants. Sensitivity analyses tested the findings' robustness by estimating E-values for unmeasured confounding and varying microvascular complication definitions. After IPTW, adjusted models revealed that diabetic neuropathy (OR 1.36, 95% CI 1.14 to 1.63) and retinopathy (OR 1.21, 95% CI 1.03 to 1.43) were significantly associated with moderate/severe periodontitis. Moreover, the coexistence of microvascular complications increased the odds 1.5-fold for moderate/severe periodontitis (OR 1.51, 95% CI 1.23 to 1.85). An effect modification of dyslipidemia on an additive scale was found, indicated by a positive relative excess risk due to interaction of 0.24 for neuropathy, 0.11 for retinopathy, and 0.44 for both complications. Sensitivity analysis ruled out unmeasured confounders and microvascular complication definitions as explanatory factors. Diabetic neuropathy and retinopathy, individually and combined, were associated with moderate/severe periodontitis. In addition, dyslipidemia had an additive positive effect modification on diabetic microvascular complications, elevating the odds of moderate/severe periodontitis. These findings may aid in identifying at-risk subgroups for diabetes-related microvascular complications and periodontitis, optimizing efforts to mitigate disease burden.