Impact of periodontal treatment on diabetes management

Background + Aims

• Diabetes mellitus (DM) is closely associated with periodontitis, with evidence suggesting a bidirectional relationship. While periodontitis may exacerbate systemic inflammation and insulin resistance, periodontal therapy is hypothesised to improve glycaemic management and reduce inflammation in people living with diabetes.
• This study aimed to evaluate whether periodontal treatment (including scaling, root planing, and antibiotics) improves glycaemic management, periodontal health, and quality of life (QoL) in metabolically unbalanced people living with diabetes.

Materials + Methods

• A randomised, open-label, two-centre controlled clinical trial involving 91 people living with diabetes (type 1 or type 2) with HbA1c levels between 7.0–9.5% and diagnosed with periodontitis.
• The participants were randomised into 2 groups:
  • Immediate Treatment Group: Non-surgical scaling and root planing (SRP), systemic antibiotics (amoxicillin 2g/day for 7 days), antiseptic irrigation, and oral hygiene instruction.
  • Delayed Treatment Group: Same periodontal intervention provided after a 3-month delay.
• The outcomes assessed were as follows:
  • Primary outcome: Change in HbA1c levels at 3 months.
  • Secondary outcomes:
    • Periodontal parameters: Probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and periodontal inflamed surface area (PISA).
    • Fructosamine levels, general and oral health-related quality of life (using SF-36 and GOHAI questionnaires).
• Statistical analyses included intention-to-treat (ITT) and per-protocol (PP) analyses, adjusting for baseline HbA1c and centre effect

Results

• Glycaemic Management:
  • No significant difference in HbA1c levels between the immediate and delayed treatment groups (adjusted mean difference: 0.04%; p = 0.67).
  • No significant changes in fructosamine levels were observed at 3 months.
• Periodontal Health:
  • Significant improvements were observed in periodontal parameters in the treatment group:
    • PPD: Reduced by 0.32 mm (p < 0.001).
    • BOP: Decreased by 13.6% (p < 0.001).
    • PISA: Reduced by 170.7 mm² (p < 0.001).
• Quality of Life:
  • Significant improvements in oral health-related QoL (GOHAI scores: adjusted mean difference = 7.0 points; p = 0.003)
  • General QoL (SF-36) showed a positive trend in the ‘General Health’ domain for type 1 diabetes patients.
• Periodontal treatment was safe, with minor adverse effects like dental hypersensitivity reported.

Limitations