Impact of diabetes on periodontal treatment

Background + Aims

• Periodontitis and diabetes mellitus (DM) are closely linked, with DM being a significant risk factor for severe periodontitis. Conversely, periodontitis may exacerbate glycaemic management in people living wiith diabetes.
• Non-surgical periodontal therapy is an effective treatment to reduce inflammation and improve periodontal health. However, there is uncertainty regarding how diabetes impacts the clinical response to periodontal treatment.
• This systematic review aimed to evaluate whether patients living with diabetes and periodontitis experience different clinical periodontal outcomes (probing depth (PD) reduction and clinical attachment level (CAL) gain) following non-surgical periodontal therapy compared to patients with periodontitis alone.

Materials + Methods

• The systematic review included prospective cohort studies analysing:
  • Periodontitis in people living with diabetes (DMP)
  • Periodontitis without diabetes (P).
• Studies included had a follow-up period up to 6-months
• Each individual underwent non-surgical periodontal therapy as the intervention.
• The systematic review assessed probing depth (PD) and clinical attachment level (CAL) gain
• A meta-analysis to pool the individual study data was conducted to analyse the PD reduction and CAL gain between DMP and P groups
• Meta-regression analyses were undertaken to explore potential factors influencing outcomes (e.g. baseline PD, age, HbA1c).

Results

• The systematic review included 12 studies (491 participants).
• Both groups experienced significant improvements in periodontal parameters after non-surgical treatment.
• There were no significant differences in PD reduction between DMP and P groups (p = 0.55).
• There were no significant differences in CAL gain between DMP and P groups (p = 0.65).
• Meta-regression analyses found the following factors may influence outcomes of treatment:
  • Baseline PD: Greater baseline PD favoured larger reduction in PD after treatment (p = 0.03).
  • Age: Older age was associated with less PD reduction in people living with diabetes (p = 0.04).
• Baseline HbA1c levels did not significantly affect treatment outcomes.

Limitations