Impact of periodontal treatment on diabetes management

Background + Aims

• Periodontitis is a severe gum disease that is common in individuals living with type 2 diabetes mellitus (T2DM), especially those with poor glycaemic management.
• There is evidence suggesting a bidirectional relationship: diabetes worsens periodontitis, while periodontitis can impair blood glucose management by increasing systemic inflammation.
• Non-surgical periodontal therapy, such as scaling and root planing (SRP), may help improve both periodontal and glycaemic outcomes.
• The study aimed to evaluate whether SRP reduces HbA1c levels and improves periodontal parameters in individuals living with T2DM and moderate-to-severe periodontitis.

Materials + Methods

• The study was a randomised controlled trial including 60 participants with T2DM (HbA1c 7%-10%) and moderate-to-severe periodontitis.
• Participants were randomly assigned to:
  • Intervention group (IG): Underwent SRP and received supportive periodontal care as needed over 6-months.
  • Control group (CG): Received delayed treatment after the study concluded.
• Key inclusion criteria:
  • Aged 40-75 years with at least 16 teeth.
  • ≥8 sites with a probing pocket depth (PPD) ≥6mm
  • ≥4 sites with clinical attachment loss (CAL) ≥5mm.
• Exclusion criteria included:
  • Recent antibiotic therapy
  • Recent periodontal therapy
  • Significant systemic conditions – for example, liver or kidney dysfunction.
• Outcomes measured at baseline, 1 month, 3 months, and 6 months:
  • Primary outcome: HbA1c levels (to assess glycaemic management).
  • Secondary outcomes: Periodontal parameters including bleeding on probing (BOP), PPD, and CAL.
• Statistical analysis accounted for baseline differences and confounding factors such as insulin use and smoking.

Results

• The IG showed significant improvements in periodontal health:
  • Reduction in BOP (38.12% vs. 4.35% in CG).
  • Improved PPD and CAL at all severity levels (p < 0.01).
• HbA1c levels decreased by 0.72% in the IG compared to 0.13% in the CG (p < 0.001).
  • This improvement was observed as early as 1 month and sustained through 6 months.
• Multivariate analysis showed that periodontal treatment independently predicted HbA1c improvement, alongside baseline HbA1c levels.
• 7 participants were lost to follow-up, but their last recorded data were included in the analysis (intention-to-treat principle).

Limitations