Periodontitis therapy not improving HbA1C levels in type II diabetes patients

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1. At 6 months, nonsurgical therapy of periodontitis was not shown to improve HbA1c  levels in type II diabetes patients. 

2. Although non-surgical periodontal treatment did improve clinical measures of chronic periodontitis, it is not recommended as method to improve glycemic control in diabetes patients. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Chronic periodontitis is an inflammatory condition of the soft and hard tissues in the mouth. While common in many adults over age 30, individuals with diabetes are places at a much greater risk. Further, it is known that well controlled diabetes decreases the severity and risk of progression of chronic periodontitis. While several studies have suggested treating periodontitis may improve glycemic control in diabetics, a causal relationship has not been conclusively shown.

The authors of this study, the Diabetes and Periodontal Therapy Trial (DPTT), set out to determine the effect of nonsurgical periodontal therapy on HbA_1c levels in individuals with type II diabetes. The results of this study demonstrate that nonsurgical therapy of periodontitis does not improve HbA_1c  levels in type II diabetes patients. Key strengths of this well-conducted study include the use of a large, diverse, population sample and a high retention rate. It is the largest study of its kind to examine the effect of periodontal therapy on diabetes.

Click to read the study in JAMA

Relevant Reading: Does periodontal treatment improve glycemic control in diabetic patients?

In-Depth [randomized controlled trial]: This large, multicenter study examined 514 individuals, randomized into two groups of 257. At 6 months, mean HbA_1c levels in the periodontal therapy group increased 0.17% (SD, 1.0) while that of the control group increased 0.11% (SD, 1.0). Intention-to-treat analyses revealed HbA_1c levels at 6 months did not differ significantly between the treatment and control groups (adjusted 6-month treatment effect, −0.05% [95% CI, -0.23% to 0.12%]; p=0.55). Periodontal clinical parameters did improve significantly at 3 months and were sustained at 6 months in the treatment group but not in the control group.

By John Prendergass and Rif Rahman

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