Acute and Chronic Diabetes Complications Associated With Self-reported Oral Health

A Retrospective Cohort Study

Kamini Kaura Parbhakar; Laura C. Rosella; Sonica Singhal; Carlos R. Quiñonez

Disclosures

BMC Oral Health. 2020;20(66) 

In This Article

Results

A total of 5183 diabetics over the age of 40 were followed through electronic medical records at ICES. As shown in Table 1, 38% of those reporting "poor to fair" oral health experienced a diabetes complication. The prevalence of chronic complications in this subgroup was 33%. In contrast, 34% of those reporting "good to excellent" oral health experienced a complication. The prevalence of chronic complications in this subgroup was approximately 29%. Both groups experienced a similar frequency of acute complications at approximately 5%.

Baseline characteristics of participants according to the diabetes outcome type are shown in Table 2. Participants who did not experience a complication were a mean age of approximately 62 years, while those who experienced an acute or chronic complication were a mean age of approximately 65 years. A majority of those who did not experience a complication were also male and self-reported higher income. The study sample was predominantly composed of individuals self-identifying as white, living in urban areas and having a post-secondary education. A greater majority of those who experienced an acute or chronic complication reported having other chronic diseases as well as a higher BMI and a longer duration of diabetes prior to the interview date. They were also current smokers, consumed alcohol regularly, lived predominantly inactive lifestyles and had not seen a dentist in the past 12 months.

The odds ratios shown in Table 3 depict the difference in the likelihood of an acute or chronic diabetes complication among study participants. In the fully adjusted multinomial regression, the odds of an acute complication versus no complication among participants reporting "poor to fair" versus "good to excellent" oral health was 10% greater [OR = 1.10, 95% CI 0.81, 1.51]. The odds of those experiencing a chronic complication in the final model, versus no complication among participants reporting "poor to fair" versus "good to excellent" oral health was 34% greater [OR = 1.34, 95% CI 1.11, 1.61].

Among covariates included in the multinomial model, age and income differences among participants were not significantly associated with the likelihood of acute and chronic complications. As sex was not found to be associated with the study outcome in the bivariate analysis, it was included in the fully adjusted model as an interaction term. However, with every unit increase in age among males and females, there was no effect on the likelihood of acute or chronic complications versus no complications. Trends are observed among education levels, self-reported general health, smoking and dental visits. For education levels, in comparison to those with a post-secondary education, those reporting having a secondary school diploma or less, had a higher likelihood of acute and chronic complications. Similarly, the further away from "good to excellent" a study participant self-reported their general health, the greater their odds for complications. Fewer dental visits and current smoking showed similar trends in comparison to those who visited the dentist more than twice in the past year and those who never smoked, respectively. A trend among those consuming alcohol regularly and occasionally was associated with greater odds of acute complications only.

Individuals identifying as an ethnic minority had higher odds for acute complications and lower odds for chronic complications. Interestingly, those who were living in rural areas, in comparison to those in urban areas, had a higher likelihood for chronic than acute complications. For every unit increase in BMI, there was only a slight but insignificant increase in the odds for chronic complications in comparison to acute complications. Those who reported having comorbidities prior to the interview date showed a similar trend leaning towards greater odds of chronic complications. However, those who had diabetes for a longer duration prior to the interview date were observed to have higher odds for acute complications than chronic complications. Those who were found to have had contact with only a general physician prior to any complication were at a lower likelihood of experiencing acute or chronic complications. In contrast, those who only had contact with a specialist were at a higher risk. Those who had contact with both a general physician and specialist were considered the reference group.

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