Association between retinopathy, nephropathy, and periodontitis in type 2 diabetic patients: a Meta-analysis

AIM: To verify the association between retinopathy, nephropathy, and periodontitis in type 2 diabetic(T2 D) patients.METHODS: Several electronic databases were available for our comprehensive search including China National Knowledge Infrastructure(CNKI), Chinese VIP Information(VIP), Wanfang, Web of Science, ScienceDirect and PubMed and were queried for relevant citations(updated to Mar. 2019). RevMan was utilized to perform Meta analysis and publication bias detection. After evaluation of the methodological quality of included studies, a fixed or random effect model was utilized to analyze data from included studies.RESULTS: A total of eight articles were finally included in this Meta analysis. In all 3987 subjects, there were 1207 T2 D patients accompanying with microvascular complications and 1734 patients with periodontitis as well. The Meta forest plot presented little heterogeneity of the eight studies(P<0.00001, I2=89%). The total effect demonstrated periodontitis was associated with overall microvascular complications(OR: 1.96, 95%CI: 1.67-2.30, Z=8.25, P<0.00001). Subgroup investigations among the studies in Asian(OR: 2.33, 95%CI: 1.91-2.85) and North American(OR: 1.42, 95%CI: 1.08-1.86) populations confirmed the existed association between retinopathy, nephropathy, and periodontitis. While the strength of such associations between periodontitis and diabetic microvascular complications were more obvious in the Asians than North Americans. All the results indicated that periodontitis was associated with diabetic retinopathy(OR: 3.77, 95%CI: 2.71-5.24), diabetic nephropathy(OR: 1.55, 95%CI: 1.24-1.94) in T2 D patients.CONCLUSION: The periodontitis is associated with diabetic retinopathy, diabetic nephropathy among T2 D patients and further large sample size clinical trials are in need to confirm the findings.