Diabetes status affects long-term changes in coronal caries - The SHIP Study

Abstract

We estimated effects of diabetes mellitus and metabolic control on long-term change in coronal caries and restorative status using 11-year-follow-up data from the population-based Study of Health in Pomerania. Data of 3731 participants with baseline and 5- and 11-year follow-up information were included. Diabetes was defined via self-reported physician´s diagnosis or intake of glucose-lowering drugs or hemoglobin A1c (HbA1c) ≥6.5% or fasting blood glucose levels ≥11.1 mmol/l. The diabetes status was defined as no diabetes (HbA1c < 6.5% or non-fasting blood glucose <11.1 mmol/l), subjects with known or undetected diabetes mellitus and HbA1c ≤ 7% (well-controlled diabetes), and subjects with known or undetected diabetes mellitus and HbA1c > 7% (poorly-controlled diabetes). The caries status was clinically assessed using the half-mouth method and the Decayed Missing Filled Surfaces (DMFS) index and its component scores were determined. Covariate-adjusted linear mixed models were evaluated. Rates in change in DMFS were significantly higher in subjects with poorly-controlled diabetes compared to subjects without diabetes. Subjects with poorly- and well-controlled diabetes had significantly higher rates in change in Missing Surfaces (MS) compared to subjects without diabetes. For the DFS, rates in change were significantly lower for subjects with well-controlled diabetes and higher for subjects with poorly-controlled diabetes as compared to subjects without diabetes. Concordantly, all rates in change increased proportional to HbA1c levels. Effects were even more pronounced in subjects with diabetes duration of ≥5 years. Subjects with poorly-controlled diabetes are at higher risk for caries progression compared to subjects without diabetes, especially in case of longer disease duration.