대한치과의사협회지 (The Journal of the Korean dental association)

  • 제47권2호
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  • Pages.90-101
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  • 2009
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  • 0376-4672(pISSN)
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  • 2713-7961(eISSN)
대한치과의사협회 (The Korean Dental Association)
권호 표지

한국인 제2형 당뇨병환자에서 치주치료가 당질 및 지질대사에 미치는 영향

Influence of periodontal treatment on the glucose and lipid metabolism in Korean type 2 diabetic patients

  • 김성흡 (연세대학교 치과대학 치주과학교실, 치주조직 재생연구소) ;
  • 홍지연 (연세대학교 치과대학 치주과학교실, 치주조직 재생연구소) ;
  • 김창성 (연세대학교 치과대학 치주과학교실, 치주조직 재생연구소) ;
  • 최성호 (연세대학교 치과대학 치주과학교실, 치주조직 재생연구소) ;
  • 조규성 (연세대학교 치과대학 치주과학교실, 치주조직 재생연구소) ;
  • 채중규 (연세대학교 치과대학 치주과학교실, 치주조직 재생연구소) ;
  • 김종관 (연세대학교 치과대학 치주과학교실, 치주조직 재생연구소)
  • Kim, Sung-Heub (Depeatment of Perideontology, Reseearch Institute for Periodontal Regeneration, College of Dentistry, Yonsei University) ;
  • Hong, Ji-Youn (Depeatment of Perideontology, Reseearch Institute for Periodontal Regeneration, College of Dentistry, Yonsei University) ;
  • Kim, Chang-Sung (Depeatment of Perideontology, Reseearch Institute for Periodontal Regeneration, College of Dentistry, Yonsei University) ;
  • Choi, Seong-Ho (Depeatment of Perideontology, Reseearch Institute for Periodontal Regeneration, College of Dentistry, Yonsei University) ;
  • Cho, Kyoo-Sung (Depeatment of Perideontology, Reseearch Institute for Periodontal Regeneration, College of Dentistry, Yonsei University) ;
  • Chae, Jung-Kiu (Depeatment of Perideontology, Reseearch Institute for Periodontal Regeneration, College of Dentistry, Yonsei University) ;
  • Kim, Chong-Kwan (Depeatment of Perideontology, Reseearch Institute for Periodontal Regeneration, College of Dentistry, Yonsei University)
  • 발행 : 2009.02.01
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초록

The aim of this study was to appraise the influence of conventional periodontal treatment on metabolic control in Korean type 2 diabetic patients. In addition, their periodontal change was compared with non-diabetic patients. Before and after treatment, it was performed to measure periodontal and metabolic indices in thirteen type 2 diabetic patients. Periodontal indices included plaque index, gingival index, bleeding on probing, probing pocket depth, gingival recession, and clinical attachment level. Metabolic indices included glycated hemoglobin(HbA1c), fasting plasma glucose, fasting plasma insulin, total cholesterol, triglyceride, and HDL-cholesterol. Plaque index, gingival index, bleeding on probing, probing pocket depth, and gingival recession showed significant improvements in the statistics. Diabetic patients showed no statistically significant differences in the changes of periodontal indices compared with non-diabetic patients. HbA1c values decreased in five of the thirteen subjects and fasting plasma glucose levels were reduced in four of the seven subjects after periodontal treatment. All five subjects whom HOMA values were calculated in showed the increases of insulin secretions. The results of this study ascertained the possibility of the better glycemic contol after conventional periodontal treatment in Korean type 2 diabetic patients and diabetes were well healed of their periodontal diseases after the treatment.

키워드

참고문헌

  1. 강두희, 생리학, 제 4판. 서울:신광출판사; 1992; 제15장 41-52
  2. 대한당뇨병학회, 당뇨병학, 제3판, 서울 : 고려의학; 2005;1-271,310-332
  3. Manoucher-Pour M, Spagnuolo PJ, Rodman HM, et al. Comparison of neutrophil chemotactic response in diabetic patients with mid and severe pericdontal disease. J Periodontol 1981;52:410-415. https://doi.org/10.1902/jop.1981.52.8.410
  4. McMullen JA., Van Dyke TE, Horoszewicz HU, Genco RJ. Neutrophil chemotaxsis in individuals with advanced periodontal disease and a genetic predisposition to diabetes mellitus. J Periodontol 1982: 52: 167-173. https://doi.org/10.1902/jop.1981.52.4.167
  5. Salvi GE. Collins JG, Yalda B, et al. Monocytic TNF-$\alpha$ secretion patterns in IDDM patients with periodontal diseases. J Clin Periodontol 1997;24:8-16. https://doi.org/10.1111/j.1600-051X.1997.tb01178.x
  6. Salvi GE, Yalda B, Collins JG, et al. Inflammatory mediator response as a potential risk marker for periodontal diseases in insulin-dependent diabetes mellitus patients. J Periodontol 1997;68:127-135. https://doi.org/10.1902/jop.1997.68.2.127
  7. Engebretson SP. Hey-Hadavi J. Ehrhardt FJ, et al. Gingival crevicular fluid levels of interleukin-1$\beta$ and glycemic control in patients with chronic periodon-titis and type 2 diabetes. J Peiodontol 2004;75:1203-1208. https://doi.org/10.1902/jop.2004.75.9.1203
  8. Ficara AJ, Levin MP, GrowerMF, Kramer GD. A comparison of the glucose and protein content of gingival crevicular fluid from diabetics and nondiabetics. J Peiodontal Res 1975;10:171-175. https://doi.org/10.1111/j.1600-0765.1975.tb00022.x
  9. Sorsa T, Ingman T, Suomalainen K, et al. Cellular souroe and tetracycline inhibition of gingival crevicular fluid collagenase of patients with labile diabetes mellitus. J Clin Periodontol 1992;19:146-149. https://doi.org/10.1111/j.1600-051X.1992.tb00454.x
  10. Willershausen-Zonnchen B. Lemmen C. Hamm G. Influence of high glucose concentrations on glycosaminoglycan and collagen synthesis in cultured human gingival fibroblasts. J Clin Periodontol 1991: 18: 190-195. https://doi.org/10.1111/j.1600-051X.1991.tb01132.x
  11. Colin HL, Uusitupa M, Niskanen L. et al. Periodontal findings in elderly patients with non-insulin dependent diabetes mellitus. J Periodontol 1998:69: 962-966. https://doi.org/10.1902/jop.1998.69.9.962
  12. Frantzis TG, Reeve CM, Brown AL. The ultrastructure of capillary basement membranes in the attached gingiva of diabetic and non-diabetic patients with periodontal disease. J Periodontol 1971;42:406-411. https://doi.org/10.1902/jop.1971.42.7.406
  13. Seppala B, Sorsa T, Ainamo J. Morphometric analysis of cellular and vascular changes in gingival connective tissue in long-term insulin-dependent diabetes. J Periodontol 1997;68:1237-1245. https://doi.org/10.1902/jop.1997.68.12.1237
  14. Schmidt AM, Weidman E. Lalla E, et al. Advanced glycated end products(AGEs) induce oxidant stress in the gingiva. A potential mechanism underlying accelerated periodontal disease associated with diabetes. J Periodontal Res 1991;31:508-515.
  15. Unlu F, Gurdal Guneri P. Hekimgil M. et al. Expression of vascular endothelial growth factor in human periodontal tissues. Comparison of healthy and diabetic patients. J Peiodontol 2003;74:181-187. https://doi.org/10.1902/jop.2003.74.2.181
  16. Katz J, Bhattacharyya I, Farkhondeh-Kish F, et al. Expression of the receptor of advanced glycation end products in gingival tissues of type 2 diabetes patients with chronic periodontal disease: A study utilizing immunohisto- chemistry and RT-PCR. J Clin Periodontol 2005;32:40-44. https://doi.org/10.1111/j.1600-051X.2004.00623.x
  17. Brian LM & Thomas WO, Diabetes mellitus and periodontal diseases. J Periodontol 2006;77:1289-1303. https://doi.org/10.1902/jop.2006.050459
  18. Taylor GW. Bidirectional interrelationships between diabetes and periodontal disease: an epidemiologic perspective. Ann periodontol 2001;6:99-112. https://doi.org/10.1902/annals.2001.6.1.99
  19. Hamdy Nassar, Alpdogan Kantarci, Thomas E. Van Dyke. Diabetic periodontitis: a mooel for activated innate immunity and impaired resolution of inflammation. Periodontology 2000 2007;43:233-244. https://doi.org/10.1111/j.1600-0757.2006.00168.x
  20. Taylor GW. Burt BA. Becker MP. et al. Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus. J Periodontol 1996 :67: 1085-1093. https://doi.org/10.1902/jop.1996.67.10s.1085
  21. Thorstensson H, Kuylensteirna J, Hugoson A. Medical status and complications in insulin-dependent diabetics. J Clin Periodontol 1996;23: 194-202. https://doi.org/10.1111/j.1600-051X.1996.tb02076.x
  22. Saremi A, Nelson RG, Tulloch-Reid M, et al. Periodontol disease and mortality in type 2 diabetes. Diabetes Care 2005;28:27-32. https://doi.org/10.2337/diacare.28.1.27
  23. Williams RC Jr. Mahan CJ. Periodontal disease and diabetes in young adults. JAMA 1960;67; 1094-1102.
  24. Miller LS. Manwell MA, Newbold D. et al. The relationship between reduction in periodontal inflammation and diabetes control : A rerport of 9 cases. J Periodontol 1992:63:843-848. https://doi.org/10.1902/jop.1992.63.10.843
  25. Seppala B, Seppala M, Ainamo J. A longitudinal study on insulin-dependent diabetes mellitus and periodontal disease. J Clin Periodontol 1993;20:161-165 https://doi.org/10.1111/j.1600-051X.1993.tb00338.x
  26. Seppala B, Ainamo J. A site-by-site follow-up study on the effect of controlled versus poorly controlled insulin-dependent diabetes mellitus. J Clin Periodontol 1994;21:161-165. https://doi.org/10.1111/j.1600-051X.1994.tb00297.x
  27. Grossi SG. Skrepcinski FB. Decaro T. et al. Treatment of periodontal disease in diabetics reduces glycated hemoglobin. J Periodontol 1997;68: 713-719. https://doi.org/10.1902/jop.1997.68.8.713
  28. Stewart JE, Wager KA, Friedlander AH & Zadeh HH. The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus. J Clin Periodontol 2001;28:306-310. https://doi.org/10.1034/j.1600-051x.2001.028004306.x
  29. Iwamoto Y, Nishmura F, Nakagawa M. et al. The effect of antimicrobial periodontal treatment on circulating tumor necrosis factor-alpha and glycated hemoglobin level in patients with type 2 diabetes. J Periodontol 2001;72:774-778. https://doi.org/10.1902/jop.2001.72.6.774
  30. Kiran M. Arpak N. Unsal E. et al. The effect of improved periodontal health on metabolc control in type 2 diabetes mellitus. J Clin Periodontol 2005;32:266-272. https://doi.org/10.1111/j.1600-051X.2005.00658.x
  31. Christgau M, Palitzsch KD, Schmalz G, et al. Healing response to non-surgical periodontal therap in patients with diabetes mellitus: Clinical, microbiological, and immundogical results. J Clin Peiodontol 1998;25:112-124. https://doi.org/10.1111/j.1600-051X.1998.tb02417.x
  32. Tervonen T. Knuuttila M, Pohjamo L. et al. Immetiate response to non-surgical periodontal treatment in subjects with diabetes millitus. J Clin Periodontol 1991;18:65-68. https://doi.org/10.1111/j.1600-051X.1991.tb01121.x
  33. Ricardo FA. Ana N, Antonio B, Clinical and metabolic changes after conven-tional treatment of type 2 diabetic patients with chronic periodontitis. J PeriodontoI 2006;77:591-598. https://doi.org/10.1902/jop.2006.050084
  34. Westfelt E, Rylander H, Blohme G. et al. The effect of periodontal therapy in diabetics. Results after 5 years. J Clin Periodontol 1996:23:92-100 https://doi.org/10.1111/j.1600-051X.1996.tb00540.x
  35. Tervonen T. Karjalainen K. Periodontal disease related to diabetic status: A plot study of the response to periodontal therapy in type 1 diabetes. J Clin Periodontol 1997;24:505-510. https://doi.org/10.1111/j.1600-051X.1997.tb00219.x
  36. Albert van de Wiel. Diabetes mellitus and alcohol. Diabetes Metab Res Rev 2004;20:263-267 https://doi.org/10.1002/dmrr.492
  37. Nilsson PM, Gudbjornsdottir S, Eliasson B, et al. Smoking is associated with increased HbA1c values and microalbuminuria in patients with diabetes-data from the National Diabetes Register in Sweden. Diabetes Metab 2004;30:261-268. https://doi.org/10.1016/S1262-3636(07)70117-9
  38. Western Pacific Regional Office of the World Health Organization, The international Obesity Task Force: The Asia-Pacific perspective:redefining obesity and its treatment. Sydney: Health Communications Australia;2000.
  39. 정혜원, 김대중, 김하동 등, 새로운 비만기준에 따른 대사증후군의 유병률, 당뇨병 2002; 26; 431-442.
  40. 이재현, 최상묵, 이만섭, 한수부, 김종권 등, 기초 및 임상치주과학, 초판, 서울 : 대림출판사; 1987; 189-223
  41. Matthews DR, Hosler JP, Rudenski AS. Homeostasis model assessment. Diabetologia 1985 ;28:412-419. https://doi.org/10.1007/BF00280883
  42. 장현하, 김진우, 류미숙 등, 한국인 제2형 당뇨병환자에서의 Homeostasis Model Assessment, 당뇨병, 2002; 26; 296-305.
  43. 김지연, 지재환, 김현진 등, 연령증가와 비단에 따른 인슐린 분비등과 감수성의 변화, 당뇨병, 2005; 29; 39-47.
  44. 송경은, 김대중, 박지원 등, 한국인 제 2형 당뇨병환자의 인슐린분비등과 인슐린 저항성이 따른 임상적 특성, 당뇨병 2007;31;128-129.
  45. 이재현, 최상묵, 이만섭, 한수부, 김종관 등, 기초 및 임상치주과학, 초판, 서울: 대림출판사; 1987; 231-245.
  46. 유해영, 제2형 당뇨 환자의 식습관, 운동습관, 스트레스, 당화혈색소와의 관련성에 관한 연구, 2001, 이화여자대학교대학원 석사학위논문.
  47. Frenzel MP, McCaul KD, Glasgow RE & Schafer LC. The relationship stress and coping to regimen adherence and glycemic control of diabetes. J Social and Clinical Psychology 1988:6:77-87. https://doi.org/10.1521/jscp.1988.6.1.77
  48. Peyrot MF & Mcmurry JF. Stress buffering and gjycemic control-The role of coping styles. Diabetes Care 1992;15:842-846. https://doi.org/10.2337/diacare.15.7.842
  49. 심완섭, 김수경, 김혜진 등, 한국인 제2형 당뇨병 환자에서 Homeostasis Model Assessment 법을 이용한 인슐린저항성 및 인슐린분비장애의 상대적 중요성에 대한 평가, 당뇨병 2005; 29; 215-223.
  50. 윤용석, 박석원, 송영득 등, Homeostasis Model Assessment법을 이용한 인슐린 저항성평가의 한계, 당뇨병 2000; 24; 541-551
  51. 강두희, 생리학 제4판, 서울:신광출판사;1992; 제13장 1-15.
  52. Chin-Lin Tseng, Michael Brimacombe, Minge Xie, et al. Seasonal patterns in monthly hemoglobin A1c values. Am J Epidemiol 2005;161:565-574. https://doi.org/10.1093/aje/kwi071
  53. Wen Wei Liang. Seasonal changes in preprandial glucose, A1c, and blood pressure in diabetic patients. Diabetes Care 2007;30:2501-2502. https://doi.org/10.2337/dc07-0597
  54. 대한당뇨병학회, 당뇨병학, 제3판, 서울:고려의학; 2005; 441-452.
  55. 허갑범, 이현철, 정윤석 등, 인슐린분비의존형 당뇨병 환자에서 인슐린 분비능력이 당질 및 지질 대사에 미치는 영향, 대한내과학회지 1994; 47; 295-304.
  56. Gadi R, Samaha FF. Dyslipidemia in type 2 diabetes mellitus. Curr Diab Rep 2007;7:228-234. https://doi.org/10.1007/s11892-007-0036-0
  57. Biesbroeck RC, Albers JJ. Wahl PW. et al. Abnormal composition of high density lipoproteins in noninsulin- dependent diabetes. Diabetes 1982;31:126-131. https://doi.org/10.2337/diab.31.2.126
  58. 민헌기, 한국인 당뇨병의 임상적 특성, 당뇨병, 1992; 16; 163-174.
  59. 허갑범, 한국인 당뇨병의 특성과 치료, 당뇨병 1997; 21; S7-14
  60. 윤건호, 한국 제2형 당뇨병환자의 병인, 당뇨병, 2007; 31; 397-403.