The Effect of Periodontal Treatment on Hemoglobin A1c Levels of Diabetic Patients: A Systematic Review and Meta-Analysis

Abstract

BackgroundThere is growing evidence that periodontal treatment may affect glycemic control in diabetic patients. And several systematic reviews have been conducted to assess the effect of periodontal treatment on diabetes outcomes. Researches of this aspect are widely concerned, and several new controlled trials have been published. The aim of this study was to update the account for recent findings.MethodsA literature search (until the end of January 2014) was carried out using various databases with language restriction to English. A randomized controlled trial (RCT) was selected if it investigated periodontal therapy for diabetic subjects compared with a control group received no periodontal treatment for at least 3 months of the follow-up period. The primary outcome was hemoglobin A1c (HbA1c), and secondary outcomes were periodontal parameters included probing pocket depth (PPD) and clinical attachment level (CAL).ResultsTen trials of 1135 patients were included in the analysis. After the follow-up of 3 months, treatment substantially lowered HbA1c compared with no treatment after periodontal therapy (–0.36%, 95%CI, −0.52% to −0.19%, P<0.0001). Clinically substantial and statistically significant reduction of PPD and CAL were found between subjects with and without treatment after periodontal therapy (PPD −0.42 mm, 95%CI: −0.60 to −0.23, P<0.00001; CAL −0.34 mm, 95%CI: −0.52 to −0.16, P = 0.0002). And there is no significant change of the level of HbA1c at the 6-month comparing with no treatment (–0.30%, 95%CI, −0.69% to 0.09%, P = 0.13).ConclusionsPeriodontal treatment leads to the modest reduction in HbA1c along with the improvement of periodontal status in diabetic patients for 3 months, and this result is consistent with previous systematic reviews. And the effect of periodontal treatment on HbA1c cannot be observed at 6-month after treatment.

An overview of systematic reviews on the effectiveness of periodontal treatment to improve glycaemic control

“…Eight SRs included randomized controlled trials (RCTs) only, and three SRs RCTs and controlled clinical trials. Most RCTs included in the SRs presented at least one of the domains assessed with unclear or high risk of bias.…”

Impact of combined non-surgical and surgical periodontal treatment in patients with type 2 diabetes mellitus-a preliminary report randomized clinical study

“…However, recent meta-analyses have suggested that this conclusion must be interpreted with care due to the limited robustness and heterogeneity of the studies available in the literature [27,28].…”

Status Update on Translation of Integrated Primary Dental-Medical Care Delivery for Management of Diabetic Patients

“…12 The guideline promoted education of diabetic patients by providers on oral hygiene and awareness of xerostomia risk (dry mouth). Both the 2013 consensus report of the Joint European Federation for Periodontology and American Academy of Periodontology Dental-Medical care delivery in T2DM workshop on periodontitis and systemic diseases 13 and metaanalysis of the impact of periodontal treatment on hemoglobin A1c levels (HbA1C), 14 concluded that guideline provision surrounding periodontal care in diabetic patients was supportable and associated with efficacy, and was further supported by meta-analysis of level A clinical trial evidence demonstrating moderate reduction in HbA1c and inflammatory biomarker levels and improvement in oral indices post intervention. 15 The American Academy of Oral Medicine also advanced evidence-based CPGs that include recommendations for optimizing clinical interventions to reduce risk of PD, caries, and oral infection in patients with Glurich, Nycz, Acharya Characterize current practice patterns for integrating dental practitioners into the medical home model.…”