Correlation Between Poor Oral Hygiene And Insulin Resistance In Type 2 Diabetes Mellitus Patients

Objective:By comparing the clinical indexes(blood biochemical indexes and periodontal indexes)of type 2 diabetes patients,the correlation of HOMA-IR,HOMA-β,Hb A1c with periodontal index and biochemical index in type 2 diabetes patients was analyzed,and the influencing factors of insulin resistance were discussed.To provide clinical evidence for periodontal inflammation as influencing factors for the development of insulin resistance in type 2 diabetes mellitus.Methods:307 inpatients with type 2 diabetes were recruited from March 2021 to August 2021in the Department of Endocrinology,the Second Hospital of Shanxi Medical University.Participants were required to fill in the questionnaire,conduct professional oral examination,take orthopantomography,and collect all clinical records and test report results of the subjects.All subjects signed informed consent.Exclusion criteria:(a)patients with edentulous jaw;(b)has other systemic diseases and serious complications;(c)periodontal treatment within half a year;(d)continuous antibiotics for one week or more within three months;(e)no oral examination;(f)Insulin injection;(g)no fasting insulin and fasting glucose test results.84 subjects were screened according to the exclusion criteria,45 of which had panoramic tomography.The questionnaire recorded the subjects’basic information,general diseases,oral hygiene habits,living and eating habits and periodontal treatment history.Clinical medical records of subjects were collected to record biochemical indicators(coagulation function,glucose,insulin,etc.).The plaque index(PLI),debris index(DI),gingival index(GI),calculus index(CI),tooth mobility and tooth missing were recorded according to the periodontal examination.The subjects were classified according to alveolar bone resorption,Hb A1c and HOMA-IR.This study adopts a cross-sectional study.Results:1.BMI grading is positively correlated with HOMA-IR(r=0.327,P=0.002).The mean BMI was different in HOMA-IR classification,compared to the mean BMI in the mild HOMA-IR group,the moderate HOMA-IR group’s was significantly higher(P=0.010).There was statistically significant difference in HOMA-IR distribution among BMI gradings,the percentage of patients with moderate and severe HOMA-IR in overweight and obese BMI group was significantly higher than that in normal BMI group(27.3%/62.8%、27.3%/58.3%).2.In terms of brushing time and appropriate exercise,the percentage of patients with severe HOMA-IR in the brushing time(27)3 minutes group was about 4 times of that in the brushing time≥3 minutes group.The proportion of moderate and severe HOMA-IR in the non exercise was significantly higher than the exercise group(73%/41%),and the difference was statistically significant.3.The distribution difference of mild,moderate and severe HOMA-IR was statistically significant among PLI,DI and CI groups(P(27)0.05).The proportion of moderate and severe HOMA-IR in PLI=3,DI=3 and CI=3 groups was higher than that in PLI=1,DI=1 and CI=1 groups(61.6%/55.6,65.4%/50%,42.3%/33.4%).4.There was a statistically significant difference in HOMA-βdistribution among DI groups,and HOMA-βin DI=2 group was significantly higher than that in DI=1 group(P=0.021).5.Hb A1c and its grouping were positively correlated with the number ofⅠ°,Ⅱ°andⅢ°movement teeth(P(27)0.05).The number ofⅢ°movement teeth significantly affects Hb A1c(P=0.041),and its linear regression equation is:Hb A1c=7.760+0.374×Ⅲ°movement teeth,R~2=0.284,indicating that the number ofⅢ°movement teeth could explain 28.4%of Hb A1c variability.There was a positive correlation between Hb A1c and alveolar bone resorption degree(r=0.353,P=0.024).The distribution of Hb A1c in alveolar bone resorption degree groups was different,and Hb A1c in alveolar bone resorption degreeⅡgroup was significantly higher than that in alveolar bone resorption degreeⅠgroup(P=0.035).6.HOMA-IR was positively related to AI(r=0.325,P(27)0.05)and inversely proportional to HDL-C(r=-0.261,P(27)0.05).Hb A1c was positively related to AI(r=0.243,P=0.035).In AI group,compared with AI(27)4,HOMA-IR and Hb A1c levels were higher in AI≥4 group(P=0.040/0.039).7.HOMA-IR was inversely proportional to APTT(r=-0.333,P=0.002),and Hb A1c group was negatively correlated with APTT(r=-0.319,P=0.004).8.In the multivariate regression analysis of HOMA-IR classification,PLI=3 and AI are independent risk factors of HOMA-IR,while non-bleeding brushing and APTT are protective factors of HOMA-IR.Compared with bleeding after brushing teeth,patients with T2DM who brushed teeth without bleeding were 0.193 times more likely to have at least one grade higher HOMA-IR rating(OR=0.193,P=0.005).T2DM patients with PLI=3 were 34.295 times more likely to have at least one grade higher HOMA-IR rating than those with PLI=1(OR=34.295,P=0.001).For every unit increase in APTT,the probability of at least one grade higher in HOMA-IR was 0.626 times(OR=0.626,P(27)0.001),and for every unit increase in AI,the probability of at least one grade higher in HOMA-IR was 1.954 times(OR=1.954,P=0.017).Conclusions:Poor oral hygiene(PLI=3,DI=3,CI=3,tooth brushing bleeding),alveolar bone resorption and increased number ofⅢ°movement teeth may aggravate the poor IR or blood glucose control in patients with T2DM.Atherosclerosis index(hyperlipidemia)and activated partial thromboplastin time(hypercoagulability)are strongly associated with IR in patients with T2DM.Among them,PLI=3 and AI are independent risk factors for IR,while non-bleeding after brushing and APTT are protective factors for IR.Patients with T2DM can effectively control and manage condition by extending the brushing time,observing whether the brushing bleeding,observing if any movement or increasing in movement of teeth and reducing the Body Mass Index.