Abstract
We estimated effects of diabetes mellitus and metabolic control on long-term change in coronal caries and restorative status using 11-year-follow-up data from the population-based Study of Health in Pomerania. Data of 3731 participants with baseline and 5- and 11-year follow-up information were included. Diabetes was defined via self-reported physician´s diagnosis or intake of glucose-lowering drugs or hemoglobin A1c (HbA1c) ≥6.5% or fasting blood glucose levels ≥11.1 mmol/l. The diabetes status was defined as no diabetes (HbA1c < 6.5% or non-fasting blood glucose <11.1 mmol/l), subjects with known or undetected diabetes mellitus and HbA1c ≤ 7% (well-controlled diabetes), and subjects with known or undetected diabetes mellitus and HbA1c > 7% (poorly-controlled diabetes). The caries status was clinically assessed using the half-mouth method and the Decayed Missing Filled Surfaces (DMFS) index and its component scores were determined. Covariate-adjusted linear mixed models were evaluated. Rates in change in DMFS were significantly higher in subjects with poorly-controlled diabetes compared to subjects without diabetes. Subjects with poorly- and well-controlled diabetes had significantly higher rates in change in Missing Surfaces (MS) compared to subjects without diabetes. For the DFS, rates in change were significantly lower for subjects with well-controlled diabetes and higher for subjects with poorly-controlled diabetes as compared to subjects without diabetes. Concordantly, all rates in change increased proportional to HbA1c levels. Effects were even more pronounced in subjects with diabetes duration of ≥5 years. Subjects with poorly-controlled diabetes are at higher risk for caries progression compared to subjects without diabetes, especially in case of longer disease duration.
Highlights
Diabetes mellitus (DM) has a global prevalence of 8.8% affecting 415 million adults and its prevalence is assumed to increase to 10.4% (642 million people) by 20401
Subjects with diabetes were older, more often male, less often highly www.nature.com/scientificreports educated, less often current smokers, and more often presented with central adiposity compared to subjects without diabetes
Rates of change in the Decayed Missing Filled Surfaces (DMFS) index and the Missing Surfaces (MS) component were significantly more pronounced in subjects with poorly controlled diabetes compared to subjects without diabetes; rates of change in the DMFS index and the decayed or filled surfaces (DFS) were significantly more pronounced in subjects with poorly controlled diabetes compared to subjects with well-controlled diabetes
Summary
Diabetes mellitus (DM) has a global prevalence of 8.8% affecting 415 million adults and its prevalence is assumed to increase to 10.4% (642 million people) by 20401. In caries susceptible subjects a decreased flow rate, a lower pH-value and a lower mineral composition in saliva are associated with a lower remineralization These caries enhancing saliva properties are further impaired in patients with DM type 2 as compared to controls without diabetes[4]. The population-based Korean National Health and Nutrition Examination Survey reported a significantly higher prevalence of untreated caries in subjects with uncontrolled diabetes compared to metabolically healthy subjects[21]. Most of these clinical studies associating diabetes with caries were of low quality, high bias susceptibility, and with total sample sizes less than 300 subjects, suggesting that most studies were potentially underpowered. This is the first investigation using prospective large-scaled population-based data
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