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Does diabetes increase the risk of periodontitis? A systematic review and meta-regression analysis of longitudinal prospective studies

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Abstract

Aim

Even though the association between diabetes and periodontitis is taken for granted, results on this association are conflicting within the literature. This systematic review assessed whether poorly controlled diabetes was associated with periodontitis onset or progression.

Methods

Electronic searches were performed in PubMed, Scopus and Embase databases. Hand search was carried out in the reference list of all articles included. Gray literature was investigated with a Google Scholar search. Prospective longitudinal studies on the association between diabetes and periodontitis were considered for this review. Studies should have presented at least two measurements of periodontal conditions over time. Data on study design, crude and adjusted estimates were collected. We used meta-analysis to estimate the pooled effect of hyperglycemia in people with diabetes on periodontitis onset or progression. Meta-regression and subgroup analyses were employed to investigate potential sources of heterogeneity between studies.

Results

Thirteen studies matched the inclusion criteria, comprising 49,262 individuals, including 3197 diagnosed with diabetes. Meta-analyses of adjusted estimates showed that diabetes increased the risk of incidence or progression of periodontitis by 86% (RR 1.86 [95% CI 1.3–2.8]). However, there is scarce information on the association between diabetes and periodontal destruction.

Conclusions

This study provides evidence that diabetes is associated with increased risk of periodontitis onset and progression in adults. Upcoming prospective longitudinal studies ought to overcome methodological caveats identified in this review.

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Authors and Affiliations

  1. Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus C, Denmark

    Gustavo G. Nascimento, Fábio R. M. Leite, Flemming Scheutz & Rodrigo López

  2. Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark

    Peter Vestergaard

  3. Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark

    Peter Vestergaard

  4. Steno Diabetes Center, Aalborg University Hospital, Aalborg, Denmark

    Peter Vestergaard

Authors
  1. Gustavo G. Nascimento
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  2. Fábio R. M. Leite
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  3. Peter Vestergaard
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  4. Flemming Scheutz
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  5. Rodrigo López
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Correspondence to Gustavo G. Nascimento.

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Appendices

Appendix 1

See Table 3.

Table 3 Excluded articles and main reason for exclusion
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Appendix 2

See Fig. 4.

Fig. 4
figure 4

Subgroup analysis of the pooled estimate by the criteria used for periodontitis assessment. Data are presented as relative risk (RR) for each study (boxes), 95% CIs (horizontal lines) and summary as RR with 95% CI (diamond)

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Appendix 3

See Fig. 5.

Fig. 5
figure 5

Quality assessment of the studies according to the Newcastle–Ottawa scale for cohort studies. Scores are displayed according to each of the three domains of the instrument: selection, comparability and outcome

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Appendix 4

See Fig. 6.

Fig. 6
figure 6

Funnel plot of studies exploring the association between diabetes mellitus and periodontitis. Information on the statistical significance of each estimate pooled in the meta-analysis can be observed according to the different colors of the plot

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Nascimento, G.G., Leite, F.R.M., Vestergaard, P. et al. Does diabetes increase the risk of periodontitis? A systematic review and meta-regression analysis of longitudinal prospective studies. Acta Diabetol 55, 653–667 (2018). https://doi.org/10.1007/s00592-018-1120-4

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