Effects of nonsurgical periodontal treatment on glycated haemoglobin on type 2 diabetes patients (PARODIA 1 study): a randomized controlled trial in a sub-Saharan Africa population

Abstract

BackgroundThere is a burglar association between diabetes and periodontitis. Many studies has shown that periodontitis treatment can help improving glycemic control in diabetes patients but little evidence of non-surgical treatment benefit is available in sub Saharan african diabetes patients. We aimed to assess the effects of non-surgical periodontal treatment (NSPT) of chronic periodontitis on glycaemic control in poorly controlled type 2 diabetes patients (T2D) in a sub-Saharan Africa urban setting.MethodsA total of 34 poorly controlled T2D patients with chronic periodontitis aged 51.4 ± 8.8 years (mean ± SD), with known duration of diabetes of 55.5 ± 42.6 months, and HbA1c of 9.3 ± 1.3% were randomly assigned to two groups. The treatment group (Group 1, n = 17) received immediate ultrasonic scaling, scaling and root planning along with subgingival 10% povidone iodine irrigation, whereas the control group (Group 2, n = 17) was assigned to receive delayed periodontal treatment 3 months later. Pharmacological treatment was unchanged and all participants received the same standardized education session on diabetes management and dental hygiene. The primary outcome was the 3-month change in HbA1c from baseline. Plaque index (PI), gingival bleeding index (GBI), pocket depth (PD), clinical attachment loss (CAL) were also assessed prior to, at 6 and 12 weeks after enrolment.ResultsTwo subjects in each group were excluded from the study. Data were analyzed on thirty patients (15 per group). Non-surgical periodontal treatment with education for better dental hygiene (group 1) significantly improved all periodontal parameters whereas education only (group 2) improved only the plaque index among all periodontal parameters. Immediate non-surgical periodontal treatment induced a reduction of HbA1c levels by 3.0 ± 2.4 points from 9.7 ± 1.6% at baseline to 6.7 ± 2.0% 3 months after NSPT, (p ˂ 0.001) but the change was not significant in group 2, from mean 8.9 ± 0.9% at baseline vs 8.1 ± 2.6% after 3 months (p = 0.24).ConclusionNon-surgical periodontal treatment markedly improved glycaemic control with an attributable reduction of 2.2 points of HbA1c in poorly controlled T2D patients in a sub Saharan setting.Trial registrationClinicalTrials.gov Identifier: NCT02745015 Date of registration: July 17, 2016 ‘Retrospectively registered’.

HbA1c changes in patients with diabetes following periodontal therapy

“…Despite the contradictory results and weak evidence of previous studies [ 18 19 20 21 ], a recent clinical study conducted by D'Aiuto et al [ 22 ] may explain the underlying causes. They noted that many small trials and meta-analyses investigating the potential beneficial effect of periodontal therapy on glycemic control have shown inconclusive findings because most of them had a small sample size and short follow-up period with uncontrolled major confounders when evaluating the association between the 2 disorders, such as the ineffectiveness of NPT in patients with diabetes.…”

Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis

“…The main reasons to exclude 49 studies were "inadequate control group" (n=25), "inadequate intervention and/ or inadequate case definition" (n=17), [65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81] "inadequate evaluation and or high risk of bias" (n=6) [82][83][84][85][86][87] (Figure 7).…”

Glycated hemoglobin influence on periodontal status, pathogens and salivary interleukins in type II diabetic Tunisian subjects with chronic periodontitis

“…These findings are in accordance with those of several earlier studies reporting elevated periodontal parameters among HbA1c in poorly controlled TIID patients. 20 , 21 …”