Alterations in HbA1c Following Minimal or Enhanced Non-surgical, Non-antibiotic Treatment of Gingivitis or Mild Periodontitis in Type 2 Diabetic Patients: A Pilot Trial

Abstract

Aim:The purpose of this pilot study was to determine and compare the effects of two protocols aimed at reducing periodontal inflammation, upon the metabolic control of the diabetic condition in subjects with elevated baseline glycosylated hemoglobin (HbA1c). Methods and Materials:Forty-two non-smoking type 2 diabetes subjects with mildly elevated HbA1c (>7 but < 9%) and severely elevated (>9%) were randomized to one of two non-surgical periodontal therapy protocols. Patients in the "minimal therapy" (MT) group received scaling, root planning, and oral hygiene instructions on two occasions six months apart. Participants randomized to the "frequent therapy" (FT) protocol received scaling, root planing, and oral hygiene instructions at two-month intervals and were provided a 0.12% chlorhexidine rinse for home use twice daily. Neither systemic nor local antibiotics were provided to either group. Subjects were asked to report any changes in diabetic medications, nutrition, and physical activity. Data analyses (ANOVA, t-test, Mann-Whitney) grouped subjects according to baseline HbA1c (>7 and < 9%, or > 9%), treatment protocol (minimal or frequent), and +/-medication change. Results:In both MT and FT groups the clinical attachment level (CAL) remained unchanged but the other measures [gingival index (GI) and pocket dept (PD)] of periodontal health improved. Mean reductions in plaque showed improvement but calculus was worse in the FT group, likely due to the use of chlorhexidine. At six months, the largest reduction of HbA1c was 3.7; experienced by a subject receiving FT but no changes in diabetic medication. Among the MT and no medication change subjects, the maximum reduction was 1.6. Abstract © Seer PublishingConclusion: Overall, modest improvements in HbA1c were detected with a trend towards FT being better than MT. Although this pilot trial was under-powered to detect small between-group differences, the magnitude of our findings (0.6 mean improvement in HbA1c) matches closely findings from the only meta-analysis conducted on this topic to date. Larger scale studies must be undertaken on diabetic patients with periodontal problems.Clinical Significance: Preventive periodontal regimens for diabetic patients should be sufficiently intense and sustained to eliminate periodontal inflammation and should be closely coordinated with the patient's overall clinical diabetic management.

Full‐mouth disinfection as a therapeutic protocol for type‐2 diabetic subjects with chronic periodontitis: Twelve‐month clinical outcomes. A randomized controlled clinical trial

“…However, these studies did not include a control group and presented marked differences in treatment protocol, study design and the type of DM, when compared with our study. Previous studies have demonstrated positive effects of the periodontal therapy on the glycemic parameters of diabetic subjects (Grossi et al 1997, Kiran et al 2005, Navarro-Sanchez et al 2007, Madden et al 2008, Koromantzos et al 2011. In this study, 12 and 13 subjects from the FMD and control groups, respectively, presented a decrease of !…”

“…Subjects under FMD and control therapies were under supportive therapies at 3, 6 and 9 months, in which they received professional plaque control, subgingival debridement, as necessary, and re-instruction of oral hygiene. Previous studies have demonstrated significant clinical improvements in diabetic subjects after FMD (Schara et al 2006) and SRP associated with the use of the CHX rinse (Madden et al 2008). However, these studies did not include a control group and presented marked differences in treatment protocol, study design and the type of DM, when compared with our study.…”

“…Studies have reported greater improvements in the glycemic condition of diabetic subjects when systemic antibiotics are used as adjunct to SRP, suggesting that the impact of periodontal treatment on glycemia may vary according the type of therapy (Grossi et al 1997, Janket et al 2005, O'Connell et al 2008. However, to date, there are insufficient data regarding the effects of the use of CHX as an adjunct to SRP (Grossi et al 1997, Madden et al 2008) and the FMD (Schara et al 2006) protocol on glycemia. Schara et al (2006), for example, showed that FMD significantly improved the glycemia of uncontrolled type-1 diabetic subjects at 3 months post-therapy.…”

“…Although some studies have revealed that periodontal treatment leads to an improvement in the glycemic control of diabetic subjects (Grossi et al 1997, Kiran et al 2005, Navarro-Sanchez et al 2007, Madden et al 2008, Koromantzos et al 2011, others have not shown meaningful positive effects of periodontal therapy on the glycemic status (Janket et al 2005, Jones et al 2007, Santos et al 2009, 2012, Correa et al 2010. Although scaling and root planing (SRP) alone, or in combination with adjunctive therapies (e.g.…”

Does It Make Sense that Diabetes is Reciprocally Associated with Periodontal Disease?

“…Overall, it seems to be obvious that periodontitis can aggravate glycemic control in diabetes [148]. Certain studies suggest that treating periodontal disease lowers HbA1c but the effects are equivocal and further studies are needed to determine the nature of the link of periodontal disease with diabetes before evidence based recommendations can be made to treat periodontal disease as a strategy of glycemic management or to prevent diabetes [149]. By the way, it must be considered that any sustained lowering of blood glucose helps the delay of the onset and progression of microvascular complications of diabetes [150,151].…”