Impact of periodontal treatment on diabetes management

Background + Aims

• The global rise in type 2 diabetes is a significant contributor to disability and early mortality, often due to vascular and renal complications. Chronic inflammation affects glycaemic control in diabetes, linking it with cardiovascular and kidney diseases. Periodontitis, a prevalent inflammatory condition often co-existing with diabetes, involves an imbalance in oral bacteria and elicits a systemic inflammatory response, raising risks for severe conditions like cardiovascular disease and renal failure. Periodontal therapy aims to manage inflammation through dental cleaning, oral hygiene advice, and possible surgical intervention.
• Prior studies have shown that periodontal treatment can reduce systemic inflammatory markers and improve vascular function. Short-term studies in patients with diabetes reported modest HbA1c reductions post-treatment. This study hypothesises that effective periodontitis treatment can further improve glycaemic control by reducing local and systemic inflammation.
• This study aims to explore whether effective periodontal treatment in type 2 diabetes patients improves metabolic control. In those who are at high risk of cardiovascular and renal complications, the study aimed to investigate the effect of periodontal treatment on these bodily functions.

Materials + Methods

• This 12-month, single-centre, investigator-masked trial assessed the impact of intensive periodontal therapy (IPT) on type 2 diabetes patients, comparing it with standard dental care (control periodontal treatment (CPT)).
• Participants were recruited from London hospitals and general medical or dental practices, had type 2 diabetes for over six months, moderate-to-severe periodontitis (≥20 teeth affected by probing pocket depth (PPD) >4mm and alveolar bone loss >30%) and at least 15 teeth. Exclusions included uncontrolled systemic diseases other than diabetes and chronic drug treatments affecting periodontal health.
• Participants were randomly assigned to IPT or CPT. They received either comprehensive subgingival scaling, surgical interventions (for IPT), or supragingival scaling and polishing (for CPT). Both groups were treated by 2 dental hygienists, 2 dentists and 3 periodontists.
• Periodontal measurements were taken at baseline and at each study visit: PPD, recession, full mouth bleeding score (FMBS), and full mouth plaque scores (FMPS).
• Other clinical measurements were taken at baseline and at each study visit, such as tobacco exposure. Blood pressure, height, body weight, waist circumference, body fat mass, fasting blood samples (measured the concentrations of glucose, standard lipid fractions, and insulin, C-reactive protein (CRP), inflammatory markers, endothelial cell surface markers were measured by multiplex assay), ultrasound imaging to assess endothelium-dependent and endothelium-independent flow-mediated dilation.
• The primary outcome assessed was the change in HbA1c at 12 months, with secondary outcomes measuring changes in glucose, lipid profiles, and kidney function.
• Results were analysed using multilevel linear regression, adjusting for baseline variables and patient characteristics.

Results

The study included 264 eligible type 2 diabetes patients with moderate-to-severe periodontitis. At baseline, groups were similar in cardiometabolic profiles. At 12 months:

• The IPT group showed a 0.6% greater reduction in HbA1c levels compared to CPT (p<0.0001), significant improvements in periodontal health, and reduced systemic inflammation (CRP and TNFα levels).
• IPT patients exhibited enhanced vascular function (flow-mediated dilation) and kidney health (eGFR).
• Improvements in periodontal parameters correlated with better glycemic control, inflammation, and vascular function.
• The IPT group also reported a higher quality of life, especially in terms of self-confidence and working life.

Limitations