Association between dental visits at primary care and glycated hemoglobin level in patients with type 2 diabetes: a cohort study

Horbach, Aurea Letícia; Baldisserotto, Julio; Celeste, Roger Keller

doi:10.1590/1980-549720210032

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Revista Brasileira de Epidemiologia

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Original Article • Rev. bras. Epidemiol. 24 • 2021 • https://doi.org/10.1590/1980-549720210032 copy

Association between dental visits at primary care and glycated hemoglobin level in patients with type 2 diabetes: a cohort study

Associação entre visitas odontológicas na atenção primária e níveis de hemoglobina glicada em pacientes com diabetes tipo 2: estudo de coorte

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

To evaluate the association between dental visits and variation in the glycated hemoglobin index (A1C) of patients with type 2 diabetes (T2DM) with well or not well glycemic control over time.

Methods:

Patients with T2DM, A1C ≥ 7% (not well-controlled) and < 7% (well-controlled), who attended a primary care service and were followed up from January 2010 to May 2018. The outcome was the variation of A1C obtained from reference laboratories. At the beginning of the study, a questionnaire with behavioral, clinical, and socioeconomic information was carried out. Multiple linear regression analyses tested interaction terms of all variables with the initial glycemic level (not well-controlled or well-controlled).

Results:

The sample consisted of 507 people, 65% women, and 66% individuals 55 to 74 years old, followed on average for 5.4 years. There was an interaction (p = 0.01) between dental visits and initial A1C. Patients not well-controlled with at least one dental visit had an average reduction in A1C of -0.56 percentage point (95%CI -1.06 – -0.56), whereas the well-controlled group who also had at least one dental visit had an increase of 0.34 percentage point (95%CI -0.18 – 0.87).

Conclusion:

Dental visits were associated with an improvement in A1C of approximately a half-percentage point in patients who had the initial A1C considered as not well-controlled.

Keywords:
Diabetes mellitus; Primary health care; Oral health; Dental care

	Total sample	Initial A1C ≥ 7%	Initial A1C < 7%
Mean (years)	5.4	5.4	5.3
95%CI	(5.2 – 5.5)	(5 – 5.5)	(5.2 – 5.7)
Minimum/Maximum (years)	0.45 / 8.33	0.45 / 8.33	0.53 / 7.99
25^th percentile	4.1	3.9	4.2
Median	6.2	6.1	6.2
75^th percentile	6.8	6.9	6.8

		N	Percentage	Change in A1C pp	(± SD)	p-value
Total		507	100.0%	-0.02	(1.95)
Initial A1C
	≥ 7%	269	53.1%	-0.59	(2.16)	< 0.01
	< 7%	238	46.9%	0.63	(1.43)
Gender
	Male	178	35.1%	0.03	(1.88)	0.32
	Female	329	64.9%	-0.05	(1.98)
Age at baseline
	< 55	82	16.2%	0.38	(2.49)	0.04
	55–74	332	65.5%	-0.06	(1.92)
	≥ 75	93	18.3%	-0.23	(1.37)
Diet
	Adequate	340	67.1%	-0.06	(1.96)	0.27
	Inadequate	106	20.9%	0.28	(1.94)
Dental visits
	None	177	34.9%	0.07	(1.63)	0.94
	Some/several	330	65.1%	-0.07	(2.10)
Medical appointments for diabetes melitus
	None	185	36.5%	-0.01	(1.75)	0.11
	1 to 2 times	200	39.4%	-0.19	(2.06)
	> 3 times	121	23.9%	0.21	(2.01)

		Initial A1C ≥ 7%				Initial A1C < 7%
		Change in pp	(SD)	N	p-value	Change in pp	(SD)	N	p-value
Total		-0.59	(2.16)	269		0.63	(1.43)	238
Gender
	Male	-0.66	(2.21)	86	0.63	0.67	(1.20)	92	0.15
	Female	-0.56	(2.13)	183		0.60	(1.55)	146
Age at baseline
	< 55	-0.49	(2.46)	49	< 0.01	1.66	(1.94)	33	0.71
	55–74	-0.59	(2.24)	173		0.51	(1.29)	159
	≥ 75	-0.73	(1.44)	47		0.29	(1.09)	46
Diet
	Adequate	-0.68	(2.12)	181	0.16	0.65	(1.46)	159	0.86
	Inadequate	-0.14	(2.17)	56		0.74	(1.54	50
Dental visits
	None	-0.22	(1.73)	96	0.04	0.41	(1.44)	81	0.02
	Some/several	-0.80	(2.34)	173		0.74	(1.41)	157
Medical appointments for diabetes melitus
	None	-0.56	(2.18)	81	0.27	0.41	(1.16)	104	0.10
	1 to 2 times	-0.80	(2.08)	119		0.71	(1.65)	81
	> 3 times	-0.33	(2.20)	68		0.91	(1.49)	53

		Initial A1C ≥ 7%		Initial A1C < 7%		Interaction^* * This p-value refers to the interaction term (coefficient estimate = 0.90 A1C p.p. 95%CI 1.63 – 0.18) between the initial A1C and dental visits; (p-value)
		change^ non-interaction terms are fixed coefficients (age and diet); they do not vary by the initial A1C categories. in pp	95%CI	change^ non-interaction terms are fixed coefficients (age and diet); they do not vary by the initial A1C categories. in pp	95%CI
Age	(every extra year)	-0.02	(-0.04 – -0.01)	-0.02	(-0.04 – -0.01)	--
Diet	Adequate	ref		ref
	Inadequate	0.34	(-0.06 – 0.74)	0.34	(-0.06 – 0.74)	--
Dental visits	None	ref		ref
Dental visits	Some/several	-0.56	(-1.06 – -0.07)	0.34	(-0.18 – 0.87)	0.01

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[1] Corresponding author: Roger Keller Celeste. Department of Preventive and Social Dentistry, Faculty of Dentistry, Universidade Federal do Rio Grande do Sul. Rua Ramiro Barcelos, 2.492, 3° andar, CEP: 90035-003, Porto Alegre, RS, Brazil. E-mail: roger.keller@ufrgs.br