Use of adjuncts in periodontal treatment for patients with diabetes

Background + Aims

• Diabetes mellitus (DM) and periodontitis are chronic conditions that may adversely affect each other.
• Patients with diabetes generally show delayed healing and higher susceptibility to infections, influencing periodontal treatment outcomes.
• Scaling and root planing (SRP) combined with systemic antibiotics, such as metronidazole (MTZ) and amoxicillin (AMX), has shown promise in improving periodontal health. However, evidence comparing the effectiveness of these adjunctive therapies between patients with and without diabetes remains limited.
• The aim of this cohort study was to compare the clinical and microbiological effects of SRP combined with MTZ and AMX in treating severe periodontitis among patients with and without type 2 diabetes (T2DM) over a 12-month period.

Materials + Methods

• 58 patients with severe periodontitis (29 with diabetes and 29 without diabetes) from previous RCTs were included
• All participants underwent SRP plus systemic MTZ (400 mg TID) and AMX (500 mg TID) for 14 days. Supportive therapy was provided at 3, 6, 9, and 12 months.
• Outcome measures were as follows:
  • Primary outcome: Proportion of patients achieving the clinical endpoint (≤4 sites with probing depth (PD) ≥5 mm).
  • Secondary outcome: Full-mouth reductions in PD and clinical attachment level (CAL), plaque and bleeding on probing (BOP), and changes in subgingival microbiota (assessed using checkerboard DNA-DNA hybridisation).
• Outcomes were compared between groups using ANCOVA with baseline adjustments.

Results

• Both groups (with and without diabetes) demonstrated significant clinical improvements at 12 months.
  • 76% of those with diabetes and 69% of non-diabetic participants achieved ≤4 sites with PD ≥5 mm.
  • Non-diabetic patients had slightly better CAL gains, particularly in moderate and deep pockets, compared to those with diabetes (p < 0.05).
• Both groups demonstrated microbiological improvements:
  • Non-diabetic patients showed greater reductions in red and orange complex pathogens (pathogens which have greater association with periodontitis).
  • Patients with diabetes had slightly higher residual levels of pathogenic bacteria post-treatment.
• Side effects (e.g., headache, diarrhea) were mild and equally distributed across groups.

Limitations