Impact of periodontal treatment on diabetes management

Background + Aims

• Parathyroid hormone (PTH) helps regulate calcium, phosphorus and bone metabolism, and stimulates the conversion of vitamin D into its active form, 1,25-dihydroxyvitamin D [1,25(OH)₂D].
• This active form supports mineral regulation and immune function and differs from 25-hydroxyvitamin D [25(OH)D] (the form commonly measured to assess vitamin D status).
• This study aimed to:
  • Investigate whether serum PTH was associated with periodontitis, whether it changed after periodontal treatment in people with type 1 diabetes, and whether these changes explained an accompanying increase in active vitamin D.

Materials + Methods

• The study combined 2 datasets:
  • A case–control comparison of 54 non-diabetic patients with periodontitis and 30 periodontally healthy controls
  • A separate treatment study involving people with type 1 diabetes.
• The diabetes cohort included 76 participants (53 never smokers, 23 current smokers) at baseline, with 53 providing complete follow-up data.
• Participants received oral hygiene education, scaling and root planing, and periodontal surgery where required. Treatment lasted an average of 15.4 weeks, with reassessment approximately 8-weeks after completion.
• Periodontal examinations measured plaque, bleeding on probing, pocket depth and attachment loss.
• Blood tests measured PTH, both vitamin D forms, calcium, phosphorus, inflammatory markers and HbA1c.
• Comparisons of PTH accounted for age, sex, smoking and, in the diabetes cohort, glycaemic control.

Results

• At baseline, serum PTH did not differ significantly between non-diabetic periodontitis patients and healthy controls, or between periodontal severity groups within the diabetes cohort.
• Following periodontal treatment in the 53 participants with type 1 diabetes assessed at follow-up:
  • Bleeding on probing decreased from 67.5% to 13.6% of sites, and pockets ≥4 mm decreased from 22.1% to 3.4%.
  • PTH increased in 61% of participants with type 1 diabetes. Mean PTH rose from 2.2 to 2.6 pmol/L overall.
    • Among 26 participants with moderate-to-severe periodontitis, PTH increased by an average of 0.6 pmol/L (p = .016).
    • The 0.2 pmol/L increase in 27 participants with no or mild periodontitis was not statistically significant.
  • Mean active vitamin D [1,25(OH)₂D] increased from 77 to 103 pmol/L.
  • Glycaemic control did not significantly improve, while calcium and phosphorus remained stable.
• Although 47% of participants had increases in both PTH and active vitamin D, the magnitude of their changes showed no significant correlation (r = .02 for absolute changes).

Limitations