Impact of periodontal treatment on diabetes management

Background + Aims

• Diabetes mellitus (DM) has associated complications, ranging from cardiovascular issues to kidney diseases, which impose a considerable burden on both those living with diabetes and the healthcare system at large. Effective management of blood sugar levels is pivotal in averting these complications and enhancing the overall outlook for individuals with diabetes.
• Concurrently, periodontitis, a prevalent chronic inflammatory condition leading to dental tissue damage, exhibits a mutual relationship with diabetes. Notably, periodontal therapy has shown promise in reducing blood glucose levels among diabetic patients. However, the impact of initial glycaemic control levels on the efficacy of such therapy remains uncertain.
• This study focuses on discerning how periodontal interventions influence glycaemic control in individuals with type 2 diabetes, with a specific emphasis on baseline HbA1c levels.

Materials + Methods

• Using the JMDC Claims Database, the study identified individuals with type 2 diabetes mellitus (T2DM) who underwent health check-ups in the fiscal years 2018 or 2019 and were followed up until the next year’s health check-up.
• The following variables were identified at the baseline health check-up: sex; age; body mass index (BMI, kg/m2); systolic and diastolic blood pressures (mmHg); smoking status; frequency of alcohol intake; and levels of triglyceride (mg/dL), low-density lipoprotein (LDL) cholesterol (mg/dL) and high-density lipoprotein (HDL) cholesterol (mg/dL).
• A weighted cohort analysis using stabilised inverse probability weights for treatment and censoring was conducted to estimate the effect of periodontal therapy on changes in HbA1c levels within a year.
• The authors aimed to assess the impact of periodontal therapy on the fluctuations in HbA1c levels over a twelve-month period. They identified various periodontal treatments, including prophylaxis, scaling and root planning (SRP), curettage of periodontal pockets, interventions to prevent severe periodontitis, supportive periodontal therapy and periodontal surgery.
• The analysis was stratified for different baseline HbA1c categories: 6.5%–6.9%, 7.0%–7.9%, and ≥8.0%.

Results

• Of the 4279 insured persons included in the study, only 957 (22%) received periodontal therapy.
• The mean duration between initiation of periodontal therapy and follow-up health check-up was 204.7 days (6-7 months).
• Overall, the study observed a tendency towards improved glycaemic control among those who received periodontal therapy in the unweighted analysis. The difference in HbA1c change between the periodontal therapy group and the no-dental-visit group was -0.035% (not statistically significant). Participants with baseline HbA1c levels of 7.0%–7.9% who received periodontal therapy exhibited statistically significantly better glycaemic control compared to those without dental visits (the difference was -0.094%). The weighted analysis showed similar findings.
• The glycaemic control improvement in participants with periodontal therapy with baseline HbA1c levels of 8.0% or higher was not statistically significant, which may be attributed to a lack of sufficient statistical power or the effects of other treatments they were receiving. In this group, both those who received periodontal therapy and those who did not visit the dentist showed a decrease in their HbA1c levels.
• Although the findings of this study were in line with previous research (which were around 0.43-0.51%), the effect size for HbA1c reduction was small.
• The sensitivity analysis using individuals without periodontal therapy as controls yielded results similar to those of the main analysis, although the difference for the subgroup with baseline HbA1c levels of 7.0%–7.9% was not statistically significant.

Limitations