Tip 2 diabetes mellitus ve periodontitisli bireylerde cerrahi olmayan periodontal tedaviye ek olarak verilen vitamin d takviyesinin etkisi
[ X ]
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Periodontal hastalık gelişiminde bakteri-konak ilişkisiyle beraber çeşitli genetik, çevresel ve kazanılmış risk föktörlerinin de rol oynadığı bilinmektedir. Diabetes Mellitus (DM)'un periodontitisin prevalans ve şiddetini artırması ile beraber periodontitis varlığının diyabetli hastalarda glisemik kontrolü zorlaştırması iki hastalık arasında çift yönlü ilişki olduğunu göstermektedir. D vitamini takviyesi Tip 2 DM (T2DM)'li hastalarda glisemik kontrolü ve insülin duyarlılığını iyileştirir. Ayrıca D vitamini, periodontitis tedavisinde takviye edici olarak kullanılabilir ve periodontal sağlığın iyileşmesine katkıda bulunur. K vitamini takviyesi insülin duyarlılığını artırır ve T2DM riskini azaltır. Bu klinik çalışmanın amacı, T2DM ve periodontitisli bireylerde cerrahi olmayan periodontal tedaviye ek olarak verilen vitamin D takviyesinin klinik ve biyokimyasal sonuçlarının araştırılmasıdır. Çalışmaya T2DM ve periodontitisli 38 birey dahil edildi. Tüm bireylerden serum ve diş eti oluğu sıvısı (DOS) örnekleri alınarak sondlama derinliği, klinik ataşman seviyesi, plak ve gingival indekslerini içeren klinik periodontal ölçümler kaydedildi. Çalışmaya dahil edilen bireyler iki gruba ayrıldı: periodontal tedavi ile birlikte D3K2 verilen bireyler test grubuna, periodontal tedavi ile birlikte plasebo verilen bireyler kontrol grubuna dahil edildi. Cerrahi olmayan periodontal tedavisi yapılan bireylerden tüm serum ve DOS örnekleri 3. ve 6. aylarda tekrar alınıp, klinik periodontal ölçümler kaydedildi. Serum örneklerinde glikozillenmiş hemoglobin A1c (HbA1c), açlık kan şekeri (AKŞ), 25(OH)D3, paratiroid hormon (PTH), kalsiyum (Ca) ve magnezyum (Mg) değerleri belirlendi. DOS ve serum IL-1ß ve IL-10 seviyeleri enzim bağlı immunosorbent analiz (ELİSA) yöntemi ile analiz edildi. Her iki grupta da tedavi sonrası 3. ve 6. ayda başlangıca göre klinik periodontal parametrelerde ve DOS hacim değerlerinde istatistiksel olarak anlamlı azalma görüldü (p<0.05). DOS hacim ve tüm klinik periodontal parametrelerde gruplar arasında tüm zaman noktalarında istatistiksel olarak anlamlı fark gözlenmedi (p>0.05). DOS IL-1ß total miktarı her iki grupta da tedavi sonrası 3.ve 6. aylarda başlangıca göre azalırken, DOS IL-10 total miktarı artış gösterdi. Serum IL-1ß değeri her iki grupta da tedavi sonrası 6.ayda başlangıca göre istatistiksel olarak anlamlı azalma gösterdi (p<0.05). HbA1c değerleri her iki grupta da tedavi sonrası 3. ve 6. aylarda başlangıca göre azaldı (p>0.05). Test grubunda 25(OH)D3 değeri tedavi sonrası 6. ayda başlangıca göre istatistiksel olarak anlamlı artış gösterdi (p=0.035). 25(OH)D3 değeri 6.ayda test grubunda kontrol grubuna göre istatistiksel olarak anlamlı yüksekti (p=0.02). HbA1c, AKŞ, Mg, Ca, ve PTH değerleri gruplar arasında tüm zaman noktalarında istatistiksel olarak anlamlı farklı değildi (p>0.05). Sonuç olarak, bu çalışmanın bulgularına göre, T2DM ve periodontitisli bireylerde cerrahi olmayan periodontal tedaviyle birlikte verilen D vitamininin sınırlı bir ek faydası bulunmaktadır. D vitamini takviyesinin etkisi ve D vitamininin hem DM hem de periodontitis ile ilişkisini gösteren biyolojik mekanizmalar ile ilgili gelecek çalışmalara ihtiyaç vardır. Anahtar Kelimeler: Periodontitis, T2DM, HbA1c, IL-1ß, IL-10, 25(OH)D3, D3K2, AKŞ.
It is known that various genetic, environmental and acquired risk factors play a role in the development of periodontal disease along with the bacteria-host relationship. The fact that diabetes mellitus (DM) increases the prevalence and severity of periodontitis, and the presence of periodontitis makes glycemic control difficult in patients with diabetes, indicating a bidirectional relationship between the two diseases. Vitamin D supplementation improves glycemic control and insulin sensitivity in patients with Type 2 DM (T2DM). In addition, vitamin D can be used as a supplement in the treatment of periodontitis and contributes to the improvement of periodontal health. Vitamin K supplementation improves insulin sensitivity and reduces the risk of T2DM. The aim of this clinical study is to investigate the clinical and biochemical results of vitamin D supplementation in addition to non-surgical periodontal treatment in individuals with T2DM and periodontitis. 38 individuals with T2DM and periodontitis were included into the study. Clinical periodontal measurements including probing depth, clinical attachment level, plaque and gingival indices were recorded by taking serum and gingival crevicular fluid (GCF) samples from all individuals. The individuals included in the study were divided into two groups: Individuals given D3K2 with periodontal therapy were included in the test group, and individuals given placebo with periodontal therapy were included in the control group. All serum and GCF samples from individuals who underwent non-surgical periodontal treatment were taken again at 3rd and 6th months, and clinical periodontal measurements were recorded. Glycated hemoglobin A1c (HbA1c), fasting blood glucose (FBG), 25(OH)D3, parathyroid hormone (PTH), calcium (Ca) and magnesium (Mg) values were determined in serum samples. GCF and serum IL-1ß and IL-10 values were analyzed by enzyme-linked immunosorbent analysis (ELISA). A statistically significant decrease was observed in clinical periodontal parameters and GCF volume values in both groups compared to baseline at the 3rd and 6th months after treatment (p<0.05). There was no statistically significant difference between the groups in GCF volume and all clinical periodontal parameters at all time points (p>0.05). While the total amount of GCF IL-1ß decreased in both groups at the 3rd and 6th months after treatment, the total amount of GCF IL-10 increased. Serum IL-1ß value showed a statistically significant decrease compared to baseline at 6th month after treatment in both groups (p<0.05). HbA1c values decreased compared to baseline at 3rd and 6th months after treatment in both groups (p>0.05). The 25(OH)D3 value in the test group increased statistically significantly at the 6th months after treatment (p=0.035). The 25(OH)D3 value was statistically significantly higher in the test group compared to the control group at the 6th months (p=0.02). HbA1c, FBG, Mg, Ca, and PTH values were not statistically significantly different between the groups at all time points (p>0.05). In conclusion, according to the findings of this study, there is limited additional benefit of vitamin D given with non-surgical periodontal therapy in individuals with T2DM and periodontitis. Future studies are needed on the effect of vitamin D supplementation and the biological mechanisms that show the relationship of vitamin D with both DM and periodontitis. Key Words: Periodontitis, T2DM, HbA1c, IL-1ß, IL-10, 25(OH)D3, D3K2, FBG.
It is known that various genetic, environmental and acquired risk factors play a role in the development of periodontal disease along with the bacteria-host relationship. The fact that diabetes mellitus (DM) increases the prevalence and severity of periodontitis, and the presence of periodontitis makes glycemic control difficult in patients with diabetes, indicating a bidirectional relationship between the two diseases. Vitamin D supplementation improves glycemic control and insulin sensitivity in patients with Type 2 DM (T2DM). In addition, vitamin D can be used as a supplement in the treatment of periodontitis and contributes to the improvement of periodontal health. Vitamin K supplementation improves insulin sensitivity and reduces the risk of T2DM. The aim of this clinical study is to investigate the clinical and biochemical results of vitamin D supplementation in addition to non-surgical periodontal treatment in individuals with T2DM and periodontitis. 38 individuals with T2DM and periodontitis were included into the study. Clinical periodontal measurements including probing depth, clinical attachment level, plaque and gingival indices were recorded by taking serum and gingival crevicular fluid (GCF) samples from all individuals. The individuals included in the study were divided into two groups: Individuals given D3K2 with periodontal therapy were included in the test group, and individuals given placebo with periodontal therapy were included in the control group. All serum and GCF samples from individuals who underwent non-surgical periodontal treatment were taken again at 3rd and 6th months, and clinical periodontal measurements were recorded. Glycated hemoglobin A1c (HbA1c), fasting blood glucose (FBG), 25(OH)D3, parathyroid hormone (PTH), calcium (Ca) and magnesium (Mg) values were determined in serum samples. GCF and serum IL-1ß and IL-10 values were analyzed by enzyme-linked immunosorbent analysis (ELISA). A statistically significant decrease was observed in clinical periodontal parameters and GCF volume values in both groups compared to baseline at the 3rd and 6th months after treatment (p<0.05). There was no statistically significant difference between the groups in GCF volume and all clinical periodontal parameters at all time points (p>0.05). While the total amount of GCF IL-1ß decreased in both groups at the 3rd and 6th months after treatment, the total amount of GCF IL-10 increased. Serum IL-1ß value showed a statistically significant decrease compared to baseline at 6th month after treatment in both groups (p<0.05). HbA1c values decreased compared to baseline at 3rd and 6th months after treatment in both groups (p>0.05). The 25(OH)D3 value in the test group increased statistically significantly at the 6th months after treatment (p=0.035). The 25(OH)D3 value was statistically significantly higher in the test group compared to the control group at the 6th months (p=0.02). HbA1c, FBG, Mg, Ca, and PTH values were not statistically significantly different between the groups at all time points (p>0.05). In conclusion, according to the findings of this study, there is limited additional benefit of vitamin D given with non-surgical periodontal therapy in individuals with T2DM and periodontitis. Future studies are needed on the effect of vitamin D supplementation and the biological mechanisms that show the relationship of vitamin D with both DM and periodontitis. Key Words: Periodontitis, T2DM, HbA1c, IL-1ß, IL-10, 25(OH)D3, D3K2, FBG.
Açıklama
Sağlık Bilimleri Enstitüsü, Periodontoloji Ana Bilim Dalı
Anahtar Kelimeler
Diş Hekimliği, Dentistry
