Effect of Periodontal Treatment on Glycemic Control of Diabetic Patients: A Systematic Review and Meta-Analysis

Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands.
Diabetes care (Impact Factor: 8.42). 02/2010; 33(2):421-7. DOI: 10.2337/dc09-1378
Source: PubMed


There is growing evidence that periodontitis may affect general health. This study was assigned to explore the robustness of observations that periodontal therapy leads to the improvement of glycemic control in diabetic patients.
A literature search (until March 2009) was carried out using two databases (MEDLINE and the Cochrane Library) with language restriction to English. Selection of publications was based on 1) original investigations, 2) controlled periodontal intervention studies where the diabetic control group received no periodontal treatment, and 3) study duration of > or =3 months.
Screening of the initial 639 identified studies and reference checking resulted in five suitable articles. A total of 371 patients were included in this analysis with periodontitis as predictor and the actual absolute change in A1C (DeltaA1C) as the outcome. The duration of follow-up was 3-9 months. All studies described a research population of type 2 diabetic patients in whom glycemic control improved after periodontal therapy compared with the control group (range DeltaA1C: Delta-1.17 up to Delta-0.05%). The studies in a meta-analysis demonstrated a weighted mean difference of DeltaA1C before and after therapy of -0.40% (95% CI -0.77 to -0.04%, P = 0.03) favoring periodontal intervention in type 2 diabetic patients. Nevertheless, this improvement in %A1C must be interpreted with care due to limited robustness as evidenced by heterogeneity among studies (59.5%, P = 0.04).
The present meta-analysis suggests that periodontal treatment leads to an improvement of glycemic control in type 2 diabetic patients for at least 3 months.

Download full-text


Available from: Wijnand J Teeuw
    • "Periodontal treatment resolves inflammation and reduces circulating cytokines among individuals with diabetes (Artese et al. 2015) and may thus reduce hyperglycemia in this group. Periodontal treatment in individuals with diabetes has been shown to reduce hemoglobin A1c (HbA1c) levels ranging from −0.36% to −65% (Teeuw et al. 2010; Engebretson and Kocher 2013; Sgolastra et al. 2013). However, the effectiveness of periodontal treatment in reducing hyperglycemia remains questionable because of concerns of heterogeneity and publication bias in the studies included in the meta-analyses, and the largest randomized controlled trial (RCT), the Diabetes and Periodontal Therapy Trial (DPTT) (n = 514), did not show any effect of periodontal treatment on HbA1c levels among individuals with type 2 diabetes (Engebretson et al. 2013). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This was a prospective cohort study evaluating 126,805 individuals with diabetes and periodontal disease receiving care at all Veterans Administration medical centers and clinics in the United States from 2005 through 2012. The exposures were periodontal treatment at baseline (PT0) and at follow-up (PT2). The outcomes were change in HbA1c following initial treatment (ΔHbA1c1) and follow-up treatment (ΔHbA1c2), and diabetes control was defined as HbA1c at <7% and <9% following initial and follow-up treatment, respectively. Marginal structural models were used to account for potential confounding and selection bias. The objective was to evaluate the impact of long-term treatment of periodontal disease on glycemic control among individuals with type 2 diabetes. Participants were 64 y old on average, 97% were men, and 71% were white. At baseline, the average diabetes duration was 4 y, 12% of participants were receiving insulin, and 60% had HbA1c <7%. After an average 1.7 y of follow-up, the mean HbA1c increased from 7.03% to 7.21%. About 29.4% of participants attended their periodontal maintenance visit following baseline. Periodontal treatment at baseline and follow-up reduced HbA1c by -0.02% and -0.074%, respectively. Treatment at follow-up increased the likelihood of individuals achieving diabetes control by 5% and 3% at the HbA1c <7% and HbA1c <9% thresholds, respectively, and was observed even among never smokers. HbA1c reduction after periodontal treatment at follow-up was greater (ΔHbA1c2 = -0.25%) among individuals with higher baseline HbA1c. Long-term periodontal care provided in a clinical setting improved long-term glycemic control among individuals with type 2 diabetes and periodontal disease.
    No preview · Article · Dec 2015 · Journal of dental research
    • "Thus, periodontal treatment such as scaling and root planing was suggested to improve glycaemic control . Indeed, these interventions reduced glycated haemoglobin (HbA1c) in type 2 diabetes patients by roughly 0.4%, as reported in recent meta-analyses (Teeuw et al. 2010, Engebretson & Kocher 2013, Wang et al. 2014). However, little is known about associations between periodontitis and moderate glycaemic disorders such as pre-diabetes and well-controlled diabetes. "
    [Show abstract] [Hide abstract]
    ABSTRACT: AimTo examine associations of prediabetes and well controlled diabetes with periodontitis.Materials and methodsThe Study of Health in Pomerania (SHIP)-Trend is a cross-sectional survey in North-Eastern Germany including 3,086 participants (49.4% men; age 20–82 years). Clinical attachment loss (CAL) and periodontal probing depth (PPD) were assessed applying a random half-mouth protocol. The number of teeth was determined. Prediabetes comprised impaired fasting glucose and impaired glucose tolerance. Previously known diabetes was defined as well controlled if glycated hemoglobin (HbA1c) was <7.0%. Participants were categorized as follows: normal glucose tolerance (NGT), prediabetes, newly detected type 2 diabetes (T2DM), known T2DM with HbA1c<7.0%, known T2DM with HbA1c≥7.0%.ResultsPrediabetes was neither associated with mean CAL and PPD in multivariable adjusted linear regression models nor with edentulism (OR=1.09 (95%-CI: 0.69-1.71)) and number of teeth (OR=0.96 (95%-CI: 0.75-1.22), lowest quartile versus higher quartiles) in logistic regression models. Associations with mean CAL and edentulism were stronger in poorly controlled previously known diabetes than in well controlled previously known diabetes (for edentulism: OR=2.19 (95%-CI: 1.18-4.05), and OR=1.40 (95%-CI: 0.82-2.38), respectively, for comparison with NGT).Conclusions Periodontitis and edentulism were associated with poorly controlled T2DM, but not with prediabetes and well controlled diabetes.This article is protected by copyright. All rights reserved.
    No preview · Article · Mar 2015 · Journal Of Clinical Periodontology
  • Source
    • "Metabolic changes occurring in DM and related pathological status may influence the reparative capacity of periodontal tissues. It has been suggested that hyperglycemia and resultant advanced glycation end product (AGE) formation, which is one of the several pathways that leads to the classic microvascular and macrovascular complications of DM, are also involved in the pathophysiology of periodontitis in diabetic subjects (Mealey & Rose 2008, Teeuw et al. 2010). The mechanisms of diabetes-mediated effects on periodontal wound healing and osseous repair have been examined in several studies; however, there is still a lack of preclinical investigation to validate the dynamic changes in the local environment and repair patterns , and molecular events during periodontal defect healing in diabetes (Chang et al. 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: AimTo evaluate the effects of fibroblast growth factor (FGF) -2 on the healing of surgical periodontal defects in rats with streptozotocin-induced early diabetes.Materials and Methods Fifty Wistar rats were assigned to streptozotocin-induced diabetes or non-diabetes group. Periodontal defects were surgically created at maxillary first molars. Defects were treated with hydroxypropyl cellulose (HPC) or FGF-2 with HPC. Defect fill was evaluated by micro-computed tomography. Histological and immunohistochemical analyses were performed.ResultsCompared to vehicle alone, FGF-2 treatment yielded significantly greater bone volume and trabecular thickness in diabetes group. Diabetes group displayed reduced new bone formation and significantly longer epithelial downgrowth compared to non-diabetes group. In diabetes group, FGF-2 treatment increased PCNA-positive cells and new bone formation after 2 weeks and suppressed epithelial downgrowth, but new cementum formation was minimal even after 4 weeks. In diabetes group, overexpression of vascular endothelial growth factor was evident in cells within connective tissue, and no significant enhancement was observed by FGF-2 treatment. FGF-2 increased the expression of α-smooth muscle actin in diabetes group.Conclusions Treatment of surgical periodontal defect in early diabetic rats with the single application of FGF-2 provided beneficial effects on new bone formation via increasing cell proliferation and regulating angiogenesis.This article is protected by copyright. All rights reserved.
    Preview · Article · Jan 2015 · Journal Of Clinical Periodontology
Show more