目的：这项随机对照试验的贝叶斯网络荟萃分析评估了牙周辅助治疗对成人2型糖尿病（T2DM）患者牙周和HbA1c结局的影响。
方法：截至2023年2月，对T2DM患者进行了系统搜索，比较了牙龈下清创（SD）联合局部或全身辅助治疗与单独SD治疗。主要结果是治疗后3至6个月报告的绝对HbA1c水平和全口探查深度的变化。
结果：检索了72篇评估27种辅助治疗的合格出版物。SD和全身性抗生素甲硝唑或SD和抗氧化剂α硫辛酸的组合，分别,1.4%（95%可信区间[CrI]0.48;2.20）和2.4%（95%CrI1.50;3.30）对HbA1c水平的改善更为显著，和0.89毫米（95％CrI0.23;1.50）和0.92毫米（95％CrI0.02;0.92）更大的牙周探诊深度减少。其他辅助治疗为牙周结局提供了额外的益处，而对HbA1c没有明显的影响。
结论：辅助使用甲硝唑或α硫辛酸是提供有临床意义的HbA1c水平和探测深度降低的最佳辅助选择。然而,由于每种辅助治疗的研究较少,以及由此产生的证据的确定性较低,因此无法得出强烈推荐.
OBJECTIVE: This Bayesian network meta-analysis of randomized controlled trials assessed the effect of adjuvant periodontal treatment in both periodontal and HbA1c outcomes in adult individuals with type 2 diabetes (T2DM).
METHODS: A systematic search was done up to February 2023 comparing sub-gingival debridement (SD) in combination with local or systemic adjuvant treatment with SD alone for individuals with T2DM. The primary outcomes were changes in absolute HbA1c levels and full-mouth probing depth reported at 3- to 6-month post-treatment.
RESULTS: Seventy-two eligible publications evaluating 27 adjuvant treatments were retrieved. The combination of SD and systemic antibiotic metronidazole or SD and antioxidant alpha lipoic acid provided, respectively, 1.4% (95% credible interval [CrI] 0.48; 2.20) and 2.4% (95% CrI 1.50; 3.30) more significant improvement on HbA1c levels, and 0.89 mm (95% CrI 0.23; 1.50) and 0.92 mm (95% CrI 0.02; 0.92) greater periodontal probing depth reductions. Other adjuvant treatments provided added benefit to the periodontal outcomes without discernible effects on HbA1c.
CONCLUSIONS: Adjuvant use of metronidazole or alpha lipoic acid was the best adjunct option to provide clinically meaningful HbA1c levels and probing depth reductions. However, no strong recommendation can be drawn due to the scarcity of studies for each adjuvant treatment and the low certainty of the resultant evidence.
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