Association Between Tooth Loss and Poor Glycemic Control in Diabetes: a Nationwide Study in Korea

초록

Background: Limited research is available on the age-and sex-specific relationships between tooth loss and poor glycemic control in patients with diabetes (DM) in Korea. Methods: Among 30,633 participants of the 2014-2017 the Korean National Health and Nutrition Examination Survey (KNHANES), a total of 2,408 participants (1,276 men and 1,132 women) with DM were included in the final analysis after exclusions. DM was defined with fasting blood glucose (FBG) level ≥ 126 mg/dL, those taking any antidiabetic medication, including both oral hypoglycemic agents and insulin injection, or those with a physician’s diagnosis of diabetes. Oral examination was performed by trained dental specialists during the KNHANES visits. The participants were categorized into three groups based on the number of remaining teeth: 0-19, 20-27, and ≥ 28. Multivariable logistic regression analysis was used to examine odds ratios (ORs) and 95% Confidence Interval (CI) for poor glycemic control, defined as glycosylated hemoglobin (HbA1c) level ≥ 6.5%, according to the number of teeth by age and sex. Secondary analysis was performed using HbA1c ≥ 7% as the cut-off value for poorer glycemic control. Results: There was no association between tooth loss and poor glycemic control (HbA1c≥ 6.5%) in men. However, a 2.35-fold (OR=2.348, 95% CI: 1.432-3.849] and 1.7-fold (1.696, 1.097-2.624) higher risk of poor glycemic control was associated in women with 0-19 or 20-27 teeth when compared with women with ≥28 teeth, respectively (all P=0.001). In women aged 40-59, 0-19 teeth showed 5.5-fold (5.503, 1.257-24.093) increased risk of poor glycemic control compared with women with ≥28 teeth (P=0.007) and in women aged ≥60, 0-19 teeth displayed 1.97-fold (1.973, 1.045-3.725) higher risk of poor glycemic control compared with women with ≥28 teeth (P=0.018). Similar trend was observed for poorer glycemic control (HbA1c≥ 7%). Only in women aged ≥60, 0-19 teeth showed a 2.57-fold (2.57, 1.365-4.838) higher risk of poorer glycemic control compared with ≥28 teeth (P=0.002). Conclusions: Tooth loss was associated with uncontrolled diabetes in only Korean women who are middle-aged and elderly. Good oral health may support better DM control in such population.