Impact of periodontal treatment on diabetes management

Background + Aims

• Diabetes mellitus (DM), particularly type 2, is a global health concern affecting millions, with complications like cardiovascular and kidney diseases linked to poor glycaemic management.
• Periodontitis, a chronic inflammatory condition damaging oral tissues, is common in people with diabetes and can exacerbate systemic inflammation, potentially impairing glycaemic management.
• Elevated HbA1c, a marker for long-term blood glucose levels management, is associated with diabetic complications. Systemic inflammation from conditions like periodontitis may worsen HbA1c levels.
• Studies suggest that managing periodontitis could improve glycaemic management in people living with diabetes by reducing inflammation.
• This review aimed to synthesise evidence on whether periodontal therapy positively influences diabetes outcomes.

Materials + Methods

• A systematic review and meta-analysis focusing on randomised controlled trials (RCTs) published since 2009.
• Studies included individuals with type 2 diabetes and periodontitis.
• Eligibility Criteria:
  • RCTs with a ≥ 3-months follow-up
  • Measuring outcomes such as HbA1c or fasting glucose. 
  • Studies with adjunctive antibiotics or antiseptic use alongside periodontal therapy were included.
• Intervention: Non-surgical and surgical periodontal therapy, including scaling, root planing, and adjunctive treatments
• Outcomes Measured:
  • Primary: Change in HbA1c levels.
  • Secondary: Indicators of periodontal health, including probing depth and bleeding on probing.
• Analysis: Pooled data from nine RCTs (719 participants) were analysed for HbA1c changes using random effects models.

Results

• The meta-analysis included 9 RCTs investigating the impact of periodontal therapy on glycaemic control in subjects with T2DM. 
• A total of 719 participants were analysed, with 398 in treatment groups and 321 in control groups. 
• All studies involved non-surgical periodontal therapy, and some included adjunctive treatments such as antibiotics or antiseptics. 
• Follow-up durations ranged from 3 to 6 months.
• The weighted mean reduction in HbA1c for the treatment groups was 0.36% (95% CI: −0.54% to −0.19%), with reductions ranging from 1.11% to 0.05% across individual studies. 
  • 8 of the 9 studies reported decreases in HbA1c for treatment groups, with 5 showing statistically significant reductions. HbA1c changes in control groups were not statistically significant.
  • The most significant reductions in HbA1c were observed in studies employing adjunctive treatments.
• Minimal heterogeneity was observed across the studies (I² = 9%). A funnel plot analysis suggested limited publication bias. 

Limitations