Impact of periodontal treatment on diabetes management

Background + Aims

• Endothelial progenitor cells (EPCs) contribute to maintaining and repairing the endothelium (the lining of blood vessels).
• Periodontitis and diabetes may alter these cells’ inflammatory responses, providing a possible biological link between periodontal disease and vascular complications.
• This study aimed to:
  • Investigate whether non-surgical periodontal treatment modifies inflammation-related gene expression in EPCs from patients with type 2 diabetes and moderate-to-severe periodontitis.

Materials + Methods

• 18 adults were randomly allocated to periodontal treatment (11 participants) or a control group receiving oral hygiene instruction alone (7 participants).
  • 1 control participant was lost to follow-up.
• Participants had diabetes for ≥5-years and HbA1c above 6.5%. People with documented cardiovascular disease were excluded.
• Treatment included oral hygiene instruction, extraction of hopeless teeth, scaling and root debridement, with review visits every 4-6 weeks. Controls received periodontal treatment after the 6-month assessment.
• Blood samples collected at baseline and 6-months were used to culture early, predominantly monocytic EPCs (cells that support blood vessel formation through signals released to surrounding cells).
• Researchers initially screened 84 genes related to Toll-like receptor signalling, a system involved in recognising microbes and activating immune responses, in four treated participants.
• Selected findings were then assessed by quantitative PCR across participants with available follow-up samples.
• Periodontal measurements, HbA1c, high-sensitivity C-reactive protein and cytokine release into cell-culture fluid were also assessed.

Results

• In the treatment group, bleeding on probing decreased from 54.6% to 16.0% of sites, while sites with pockets ≥4 mm decreased from 26.9% to 6.0%. Changes were significantly better than in controls.
• The initial screen identified significant reductions in IL-6 and IL-8 transcripts, the RNA instructions used to produce these inflammatory signalling proteins.
• Changes in IL-6 and IL-8 gene expression significantly favoured treatment over control (p < .01 and p < .05, respectively), although responses varied between individuals.
• Reduced gene expression was not accompanied by a significant decrease in IL-6 or IL-8 protein levels in the culture fluid.
• No demonstrated glycaemic benefit as HbA1c did not improve; mean values increased in both groups, without a significant difference in change between groups.
• No significant systemic inflammatory effect as changes in high-sensitivity C-reactive protein did not differ significantly between groups.

Limitations