Periodontal treatment may improve metabolic control in diabetic patients.

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There have been a number of studies including a recent Cochrane review which have looked at the impact of periodontal treatment on glycaemic control in diabetics. The aim of this study was to investigate the effects of nonsurgical periodontal therapy on metabolic control in Type 2 diabetes mellitus (DM2)

Forty patients with DM2 and chronic periodontitis [mean age = 50.29 years; mean glycated haemoglobin (HbA1c) = 8.72] were randomly assigned to two groups.  Those in the treatment group (n=22) received full-mouth scaling and root planing, while those in the control group (n = 18) received no periodontal treatment.  Gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), fasting plasma glucose (FPG), HbA1c, total cholesterol (TC), triglyceride (TG) and cholesterol levels were recorded at baseline and compared to data collected three months later.

The groups were similar at baseline

  • at  3 months all periodontal parameters had improved significantly in the treatment group.
  • HbA1c levels decreased in the treated group (p = 0.003).
  • In the same time period, FPG, GI, PPD and CAL increased in the control group (p = 0.016,
  • 0.0, 0.0 and 0.004, respectively) but HbA1c did not change significantly.

The authors concluded that

Non-surgical periodontal therapy could improve metabolic control in diabetic patients.

Moeintaghavi, A., Arab, H., Bozorgnia, Y., Kianoush, K. and Alizadeh, M. (2012), Non-surgical periodontal therapy affects metabolic control in diabetics: a randomized controlled clinical trial. Australian Dental Journal, 57: 31–37. doi: 10.1111/j.1834-7819.2011.01652.x

Related reviews

2010 saw the publication of two systematic reviews in recent years addressing this same questio . A Cochrane review from Simpson et al concluded:-

There is some evidence of improvement in metabolic control in people with diabetes, after treating periodontal disease. There are few studies available and individually these lacked the power to detect a significant effect. Most of the participants in the study had poorly controlled Type 2 DM with little data from randomised trials on the effects on people with Type 1 DM.

Improving periodontal health is an important objective in itself. However, in order to understand the potential of this treatment to improve glycaemic control among people with diabetes, larger, carefully conducted and reported studies are needed.

Simpson TC, Needleman I, Wild SH, Moles DR, Mills EJ. Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database of Systematic Reviews 2010, Issue 5. Art. No.: CD004714. DOI: 10.1002/14651858.CD004714.pub2.

 The second review from Teeuw WJ et al  had a similar conclusion:-

The present meta-analysis suggests that periodontal treatment leads to an improvement of glycemic control in type 2 diabetic patients for at least 3 months.

 Teeuw WJ, Gerdes VE, Loos BG. Effect of periodontal treatment on glycemic control of diabetic patients: a systematic review and meta-analysis. Diabetes Care. 2010 Feb;33(2):421-7. Review. PubMed PMID: 20103557; PubMed Central PMCID: PMC2809296.

 

While this new study by Moeintaghavi, A  et al  does add to our knowledge in this area it is still  a small study.  The Cochrane review  suggested a two-phase approach for further inverstigation

  • Firstly, a limited number of additional randomised controlled trials (RCTs) investigating the impact of periodontal therapy on glycaemic control.
  • Secondly, if the evidence indicates clearly a potentially clinically significant benefit, community-based trials should be conducted.

This new study fits ito the first phase but on its own is not sufficiently powered to move to larger community-based trials.

 

 

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