探討牙結石清除及齒齦下刮除術對糖尿病病人照護結果及利用之影響

Abstract

背景：對於第二型糖尿病患而言，有伴隨嚴重牙周病其糖化血色素(HbA1c)會顯著上升，進行非手術性牙周治療介入，則可以降低HbA1c值。然國外有關糖尿病與牙周治療介入之相關實證研究結果存在不一致性，且目前國內尚缺乏相關大型研究資料。 目的：探討第二型糖尿病伴隨有牙周病的病人，其以牙結石清除或齒齦下刮除術治療介入後，後續對於糖尿病照護結果與醫療利用之間的關係。 方法：採回溯性世代研究設計以全民健康保險資料庫進行次級資料分析，使用2017年診斷為第二型糖尿病伴隨有牙周病的病人為研究對象，透過傾向分數配對法降低干擾作用，了解其有無接受牙周治療介入，其對於2018年糖尿病照護結果與醫療利用之差異。 結果：以牙結石清除或齒齦下刮除術治療介入後，相較沒接受治療者：其後續HbA1c控制在7%以內的勝算比為1.065倍、減少13%腎臟病變風險、減少27%住院風險；西醫門診次數、牙醫門診次數及牙醫總醫療費用上升；平均住院天數、住院總醫療費用及總體(含門住診)醫療費用下降。 結論與建議：有牙周病的第二型糖尿病患有接受牙周治療者，其後續糖尿病照護結果較佳，住院及總體醫療利用情形也會較低。因此建議衛生主管機關可考量將牙醫師納入糖尿病照護團隊的一環，並建立相關轉介管道與機制。

Background: Hemoglobin A1c(HbA1c) is associated with severe periodontal ailment among patients with type 2 diabetes, and can be lowered by non-surgical periodontal treatment. However, data from empirical studies on diabetes and periodontal treatment interventions are not robust, as Taiwan lacks population-based data. Objective: To evaluate the effect of dental scaling and subgingival curettage on outcomes and healthcare utilization among patients with diabetes. Methods: The retrospective cohort study was designed using the database of National Health Insurance for secondary analysis. Patients diagnosed with type 2 diabetes and periodontal disease in 2017 were selected, and we have used propensity score matching to reduce bias between treatment and control groups on a large number of covariates. If the difference between the results of 2017 and 2018 diabetes outcomes and utilization is due to periodontal treatment intervention is to be ascertained. Results: After dental scaling or subgingival curettage, compared with those who did not receive the treatment, the ratio of odds of subsequent HbA1c below 7% was 1.065, and the risk of renal ailment was lower by 13%, and of hospitalization by 27%. The data analysis shows that there was an increase in the number of medical outpatient visits, of dental visits, and total dental expenses, but there was decrease in the average length of hospital stays, total hospitalization expenses, and overall medical expenses. Conclusions: Patients with type 2 diabetes and periodontal disease who have received periodontal treatment have better subsequent diabetes outcomes, and lower hospitalization need and overall medical care. Hence, we recommend that health policymakers consider the inclusion of dentists in Diabetes Shared Care team and institute relevant referral systems.