IMPORTANCE Chronic periodontitis, a destructive inflammatory disorder of the supporting structures of the teeth, is prevalent in patients with diabetes. Limited evidence suggests that periodontal therapy may improve glycemic control. OBJECTIVE To determine if nonsurgical periodontal treatment reduces levels of glycated hemoglobin (HbA 1c) in persons with type 2 diabetes and moderate to advanced chronic periodontitis. DESIGN, SETTING, AND PARTICIPANTS The Diabetes and Periodontal Therapy Trial (DPTT), a 6-month, single-masked, multicenter, randomized clinical trial. Participants had type 2 diabetes, were taking stable doses of medications, had HbA 1c levels between 7% and less than 9%, and untreated chronic periodontitis. Five hundred fourteen participants were enrolled between November 2009 and March 2012 from diabetes and dental clinics and communities affiliated with 5 academic medical centers. INTERVENTIONS The treatment group (n = 257) received scaling and root planing plus chlorhexidine oral rinse at baseline and supportive periodontal therapy at 3 and 6 months. The control group (n = 257) received no treatment for 6 months. MAIN OUTCOMES AND MEASURES Difference in change in HbA 1c level from baseline between groups at 6 months. Secondary outcomes included changes in probing pocket depths, clinical attachment loss, bleeding on probing, gingival index, fasting glucose level, and Homeostasis Model Assessment (HOMA2) score. RESULTS Enrollment was stopped early because of futility. At 6 months, mean HbA 1c levels in the periodontal therapy group increased 0.17% (SD, 1.0), compared with 0.11% (SD, 1.0) in the control group, with no significant difference between groups based on a linear regression model adjusting for clinical site (mean difference, −0.05% [95% CI, −0.23% to 0.12%]; P = .55). Periodontal measures improved in the treatment group compared with the control group at 6 months, with adjusted between-group differences of 0.28 mm (95% CI, 0.18 to 0.37) for probing depth, 0.25 mm (95% CI, 0.14 to 0.36) for clinical attachment loss, 13.1% (95% CI, 8.1% to 18.1%) for bleeding on probing, and 0.27 (95% CI, 0.17 to 0.37) for gingival index (P < .001 for all). CONCLUSIONS AND RELEVANCE Nonsurgical periodontal therapy did not improve glycemic control in patients with type 2 diabetes and moderate to advanced chronic periodontitis. These findings do not support the use of nonsurgical periodontal treatment in patients with diabetes for the purpose of lowering levels of HbA 1c .

Objectives-We evaluated the impact of a mailed, tailored intervention on skin cancer prevention and skin self-examination behaviors of adults at moderate and high risk for skin cancer.Methods-Adults at moderate and high risk for skin cancer were recruited in primary health care settings in Honolulu, HI, and Long Island, NY. After completing a baseline survey, participants were randomized to 2 groups. The treatment group received tailored materials, including personalized risk feedback, and the control group received general educational materials. Multivariate analyses compared sun protection and skin self-examination between groups, controlling for location, risk level, gender, and age.Results-A total of 596 adults completed the trial. The tailored materials had a significant effect on overall sun-protection habits, the use of hats, the use of sunglasses, and the recency of skin selfexamination. Some effects were moderated by location and risk level.Conclusions-Tailored communications including personalized risk feedback can improve sunprotection behaviors and skin self-examination among adults at increased risk for skin cancer. These convenient, low-cost interventions can be implemented in a variety of settings and should be tested further to assess their long-term effectiveness.Skin cancer is the most commonly diagnosed cancer in the United States, 1 with more than 1 million Americans diagnosed with skin cancer each year. 2 The incidence of skin cancer has increased dramatically worldwide in the last decade. 3 Both main types of skin cancermalignant melanoma and nonmelanoma skin cancer-are now significant and costly public health concerns. 2,4 Although skin cancer rates are increasing, it is considered one of the most preventable types of cancer. Prevention guidelines include reducing exposure to ultraviolet radiation (UVR); adopting sun-protection habits including the use of sunscreen, hats, shirts, and sunglasses 5,6 ; performing regular skin self-examination; and seeking professional Correspondence should be sent to Karen Glanz, Department of Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, 801 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021 (kglanz@upenn.edu).. Contributors K. Glanz conceptualized, designed, and directed the study; supervised data collection in Hawaii; and was the article's primary author. E. R. Schoenfeld assisted with study design, supervised data collection in New York, and contributed to the writing of the article. A. Steffen conducted data analyses and contributed to the writing of the article. All authors helped to interpret findings and review drafts of the article.Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link. Human Participant Protection NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript evaluation of suspicious skin changes. Nevertheless, levels of knowledge, concern, and the practice of prevention and early detection remain relatively low. 7,8 Risk factors for s...

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