Impact of periodontal treatment on diabetes management

Background + Aims

• Type 2 Diabetes Mellitus (T2DM) is prevalent in Hispanic populations, significantly affected by socioeconomic factors.
• Periodontitis, a chronic inflammatory disease, has been linked to worsened glycaemic management and increased number of diabetic complications.
• This study aims to evaluate whether non-surgical periodontal therapy (scaling and root planing (SRP)) improves glycated haemoglobin (HbA1c) levels and periodontal health in Hispanic individuals with T2DM and moderate-to-severe chronic periodontitis.

Materials + Methods

• Randomised controlled trial (RCT) with 154 participants split equally into a treatment group (SRP and oral hygiene education) and a control group (oral hygiene education only).
• Inclusion criteria included:
  • Hispanic adults aged ≥18 years
  • Diagnosed with T2DM
  • Moderate-to-severe chronic periodontitis
• Exclusions included:
  • Recent systemic antibiotic use
  • Recent dental treatment.
• The experimental group underwent SRP performed by trained periodontists, while controls received oral hygiene education. Periodontal parameters were assessed with calibrated periodontal probes.
• HbA1c was measured using a standardised boronate affinity assay.
• Periodontal measurements were repeated 4–6 weeks after SRP in the treatment group and 4–6 weeks after baseline in controls. HbA1c was measured at baseline and four months after baseline; a four-month periodontal reassessment was not reported.
• Outcomes:
  • Primary – change in HbA1c levels at 4 months.
  • Secondary – change in periodontal parameters, including probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP).
• Changes in HbA1c and periodontal parameters were compared using regression analysis and statistical tests, with significance set at p<0.05.

Results

• The final results and tables included 126 participants: 66 in the SRP group and 60 in the control group, from 154 originally randomised.
• The test and control groups demonstrated no significant differences in baseline characteristics.
• Mean HbA1c decreased from 9.0% to 8.4% in the SRP group and from 8.4% to 8.1% in controls: reductions of 0.6 and 0.3 percentage points, respectively. The between-group difference in change was not statistically significant (p = 0.89). Neither within-group reduction was significant (p = 0.09 and p = 0.10, respectively).
• Significant improvements in periodontal health (reduction in PPD, CAL gain, and reduced BOP) were observed in the SRP group compared to controls.
• Both groups showed some periodontal improvements after receiving oral hygiene education; the SRP group generally showed greater improvements.
• No significant association was found between changes in HbA1c and changes in bleeding on probing. Increased diabetes medication was associated with HbA1c reduction, but analyses excluding participants with medication changes still found no significant difference between treatment groups.

Limitations

• The study population was limited to a Hispanic demographic, reducing generalisability.
• Diet and physical activity were not assessed and may have influenced glycaemic control. Diabetes medication changes were recorded and considered in regression and subgroup analyses.
• Baseline variability in HbA1c levels (ranging from 5.7% to 16%) may have impacted results.
• Periodontal outcomes were assessed after only 4–6 weeks, whereas HbA1c was reassessed at four months. The persistence of periodontal improvements at the time of the final HbA1c measurement was therefore not established.
• Control subjects demonstrated some periodontal improvements despite no mechanical therapy, likely due to improved oral hygiene practices introduced during the study.

Conclusion

• Scaling and root planing produced greater short-term periodontal improvements than oral hygiene education alone, but did not demonstrate an additional HbA1c benefit at four months.
• Periodontal outcomes were assessed after only 4–6 weeks, so their longer-term persistence was not established.