• Can treating oral inflammation lead to the reduction in a systemic outcome? A systematic review looking into pregnancy and diabetes.

      Guy, Veronica; Oates, Thomas W. (2018)
      The contribution of periodontal disease to the development of adverse systemic consequences remains controversial. It is hypothesized that inconsistencies between studies is due in part to limitations in study design. This review assessed systemic conditions including adverse pregnancy outcomes and glycemic control for patients with diabetes in a combined manner based on a shared inflammatory mechanism of consequence. It is thought that the systemic consequences of periodontal inflammation can directly influence these systemic conditions. Therefore, this systematic review aimed to evaluate the consideration of the patients' medical management during the study and also the number of study participants as two important factors influencing the study outcomes. An article search was performed using OVID Medline, Cochrane library and EMBASE and a manual search was performed through November 2017. Randomized controlled trials published between 2000 and 2017 looking into the effectiveness of periodontal therapy on the rate of pre-term birth in a pregnant population and on glycated hemoglobin A1c in a type 2 diabetics were included. Primary outcomes were changes in HbA1c and differences in frequency of occurrence of pre-term birth. Medical management of the systemic condition under study was categorized from 0-3, based on stringency of study design and consideration for medical management during study participation. Risk of bias regarding randomization, allocation of sequence concealment, blinding, incomplete outcome data, selective outcome reporting and other biases were averaged using a cumulative assessment of factors considered in prior systematic reviews with shared studies. After article selection, randomized controlled trials including 17 on diabetes and 13 on pregnancy were combined for evaluation. Both increased sample size (R2=0.09, R value = 0.3) and improved stringency of medical management (Figures 13 & 14) were associated with diminished effects of periodontal therapy on systemic outcomes. Interestingly, risk of bias as assessed in previous systematic reviews showed a modest correlation (R2=0.104, R value= 0.32) with primary outcomes. This systematic review demonstrates that the disparate results in studies of periodontal therapy affecting systemic outcomes may be explained in part by study design, specifically stringency in consideration of medical management and sample size. The potential for confounding factors influencing outcomes remains a concern.
    • Use of Insulin and Risk of Cancer among Patients with Diabetes Mellitus: A Nonconcurrent Prospective Study

      Lu, Zhiqiang; Weiss-Smith, Sheila (2011-01)
      Objectives: There have been a number of studies showing an association between diabetes and cancer risk and a growing concern that this risk maybe linked to insulin therapy. This study aimed to (1) to assess the effect of insulin exposure on the risk of developing solid cancer among patients with diabetes mellitus; and (2) to explore the role of HbA1c value in modifying the risk. Methods: The study used the General Practice Research Database (GPRD), a large UK-based research database of patient electronic health records from general practitioners, to explore the use of insulin on the risk of cancer. Cox's Proportional hazards models were used to estimate the hazard ratio of solid tumors, all sites and selected individual sites, by types of antidiabetic therapy. The potential modifying role of diabetes control as measured by hemoglobin A1c (HbA1c) was also explored. Results: The study cohort contained a total of 230,330 patients with claims for antidiabetic therapy. The study found that use of insulin alone or in combination with other oral agents was associated with an increased risk of cancer. Insulin use was strongly associated with pancreatic cancer risk (HR=1.875, 95% CI 1.261, 2.787 for insulin alone and HR=2.330, 95% CI 2.007, 2.705 for insulin with oral agents). Moreover, HbA1c appears to be a risk factor for pancreatic cancer (HR=1.385, 95% CI 1.324, 1.450). The risk of pancreatic cancer was similarly increased for premixed and intermediate-acting insulin when compared with short-acting insulins. Role of HbA1c value in modifying the risk of cancer among patients with diabetes varies across different cancer types. Conclusion: Use of insulin, alone or in combination with oral agents, may pose a strong risk for pancreatic cancer and overall cancer. Use of insulin alone was also associated with an increased risk of colorectal cancer. These data suggest that there may be more than one mechanism by which insulin therapy impacts the risk of cancer among diabetics. Glucose control appears to impact the risk of pancreatic cancer, though it may be an independent factor for some common tumors. Caution should be used when prescribing insulin to patients for diabetes management.