Impact of periodontal treatment on diabetes management

Background + Aims

• Patients with type 2 diabetes mellitus (T2DM) exhibit higher prevalence and severity of chronic periodontitis compared to individuals without diabetes.
• Non-surgical periodontal therapy (NSPT), including scaling and root planing (SRP), has been suggested to improve glycaemic control in T2DM patients.
• Conventional NSPT involves multiple sessions usually treating quadrant-by-quadrant (Q-by-Q), while an intensive, one-stage approach involves treating the whole mouth within 24-hours. The latter is thought to reduce bacterial translocation and may yield similar or superior outcomes.
• This study aims to compare the effects of one-stage SRP and conventional quadrant-by-quadrant (Q by Q) SRP on HbA1c levels, periodontal parameters, fasting plasma glucose (FPG), and C-reactive protein (CRP) in T2DM patients with poor glycaemic control.

Materials + Methods

• This study design involved a prospective, parallel, randomised controlled trial (RCT)
• A total of 93 participants with glycosylated haemoglobin (HbA1c) ≥ 7% were randomized into two groups: one-stage SRP within 24 hours or Q-by-Q SRP over multiple sessions. Treatments were conducted by two specialist periodontitis, and both groups received consistent oral hygiene education and supportive therapy at 3- and 6-months post-treatment.
• Blood samples for HbA1c, FPG, and CRP were collected at baseline, 3- and 6-months.
• Periodontal parameters, including probing pocket depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP), were assessed at six sites per tooth by a calibrated examiner blinded to treatment protocols.
• Metabolic and clinical outcomes were analysed using generalized equation estimation (GEE) models and linear regression adjusted for confounders (e.g. smoking).
• Statistical analyses included bootstrapping to address model assumptions, with results analysed using Stata software. This robust design aimed to clarify the impact of periodontal therapy on glycaemic control and systemic inflammation in T2DM patients.
• The outcomes assessed were as follows:
  • Primary outcome: The change in HbA1c levels at 6-months
  • Secondary outcomes: The changes in FPG, CRP, and periodontal clinical parameters.

Results

• Of the 93 enrolled participants, 74 completed the study. Both groups were similar in demographic, metabolic, and periodontal characteristics at baseline, except for smoking rates, which were adjusted for in the analysis.
• At 6-months, HbA1c levels decreased by 0.48% in the Q-by-Q group and 0.18% in the one-stage group, with no statistically significant differences between modalities (p = 0.455).
• Patients with baseline HbA1c ≥ 9% showed a significant reduction of 0.88% after therapy (p = 0.006), while those with HbA1c < 9% experienced a slight, non-significant increase of 0.31% (p = 0.145).
• FPG levels and CRP showed variable changes, with no significant differences between the treatment groups at 3- or 6-months.
• Periodontal parameters, including PPD and CAL, improved significantly in both groups post-treatment.
• Both modalities were well-tolerated, with minor adverse effects such as root sensitivity reported.

Limitations