Review confirms link between perio disease and diabetes

2016 09 23 15 10 42 184 Diabetes 400

A new systematic review further supports the link between periodontal disease and diabetes. Periodontal treatment moderately but significantly improved glycemic control in patients with diabetes, the authors found.

They looked through evidence in recently published meta-analyses of clinical trials. Their findings further confirm that periodontal treatment can reduce hemoglobin A1c (HbA1c) levels, an indicator of how well diabetes is being controlled.

"Evidence from recent meta-analyses of [randomized clinical trials] shows that periodontal treatment results in a significant reduction of HbA1c levels," wrote the authors, led by Phoebus Madianos, DDS, PhD (Journal of Clinical Periodontology, February 2018, Vol. 45:2, 188-195). Dr. Madianos is a professor of periodontology at the University of Athens School of Dentistry in Athens, Greece.

Moderate effect on glycemic control

The current review was specifically designed as an update to a 2013 systematic review on the same topic. The previous review found that HbA1c levels were modestly reduced after periodontal treatment. However, the authors of the 2013 review stated they had limited confidence in the conclusion because of a lack of multicenter clinical trials.

“Periodontal treatment results in a significant reduction of HbA1c levels.”
— Phoebus Madianos, DDS, PhD

The authors of this review, therefore, looked at more recent scientific articles on the link between periodontal treatment and glycemic control in patients with type 1 and type 2 diabetes. In the final review, they focused on eight meta-analyses of randomized clinical trials published between January 2013 and February 2017. The analyses included newer, multicenter clinical trials that were not available during the original 2013 review.

The new review found that nonsurgical periodontal therapy moderately but significantly improved glycemic control in patients with diabetes, a finding that is consistent with the 2013 review. Patients who underwent periodontal treatment had about half a percent lower HbA1c levels three months after treatment than those who did not undergo periodontal therapy.

"Evidence from the literature suggests that successful periodontal treatment, which results in the reduction of inflammation from the periodontal tissues, improves the metabolic control of people with diabetes mellitus," the authors wrote.

However, periodontal treatment did not have a long-term impact on glycemic control of patients with diabetes, they found. The use of antibiotic medication as an adjunct therapy also did not significantly further reduce HbA1c levels.

High-quality evidence

The majority of the meta-analyses included in the systematic review contained high-quality evidence, giving the authors confidence in their findings. However, it was not uncommon for the included meta-analyses to have overlapping randomized clinical trials, and the authors of the meta-analyses themselves cautioned that there were large differences in how the clinical trials were conducted.

Nevertheless, the new and older evidence both support that periodontal treatment can moderately improve glycemic control in diabetes patients, even if the results are only short-term.

"The magnitude of the reduction in HbA1c, which is found to be associated with nonsurgical periodontal treatment in patients with diabetes, seems to have clinically significant effects on systemic health, and thus should have a place in the treatment of diabetic patients," the authors noted.

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