Effect of nonsurgical periodontal treatment on glycosylated hemoglobin in diabetic patients: a systematic review

Abstract

This review was designed to determine whether non-surgical periodontal treatment is able to reduce serum glycosylated hemoglobin (HbA1c) levels in patients with diabetes mellitus (DM). Several previous reports showed that scaling and root planning (SRP) improve periodontal status in patients with DM, but whether it also improves metabolic control of the disease is unclear. A systematic review was conducted according to the recommendations of the Cochrane Collaboration and PRISMA. A literature search was conducted in October 2012 using three libraries (Cochrane, Web of Knowledge, and Scopus) and the keywords "periodontal disease" and "diabetes mellitus." Only 21 of the articles met the inclusion criteria for this review. A total of 1,454 patients were thus included in this study to evaluate whether periodontal treatment improved serum HbA1c levels. Both the methodological quality and the risk of bias of each study were taken into account using the Jadad scale. Only ten of the included studies had an acceptable-good score of 3-5. Fourteen of the studies reported a significant decrease in serum HbA1c levels (p < 0.05) after periodontal treatment. The remaining seven studies failed to find a significant decrease in serum HbA1c. The findings of this review suggest that the published literature is insufficient and inconclusive to clearly support periodontal treatment as a means to improve serum HbA1c levels in patients with type 1 DM. It also demonstrates the need for homogeneous studies, with larger samples and longer follow-up periods, to properly address this question.

Evidence summary: The relationship between oral diseases and diabetes

“…One high quality systematic review provides evidence that in patients with type 2 diabetes, intensive periodontal therapy involving scaling and root planning reduced HbA1c (a marker of glycaemic control) by 0.29% [3-4 mmol/l] for up to three months; however, after six months there was no evidence that this reduction was sustained (16). Modest improvements in glycaemic control, as demonstrated by a reduction in Hb1Ac, are supported by seven other moderate quality systematic reviews (15,(17)(18)(19)(20)(21)(22); whilst one was equivocal (23). In one of the reviews by Wang et al 2014, after three months follow-up, periodontal treatment substantially lowered HbA1c compared with no treatment (-0.36%, 95%CI, 0.52% to 0.19%, P < 0.0001).…”

Benefits of non‐surgical periodontal treatment in patients with type 2 diabetes mellitus and chronic periodontitis: A randomized controlled trial

“…Despite periodontal therapy seems to improve metabolic control, evidence is not enough to support significant association between periodontal therapy and metabolic control in diabetic patients. More evidence is needed (Mauri-Obradors, Jané-Salas, Sabater-Recolons, Vinas, & López-López, 2015;Wang, Jen, Chou, & Lei, 2014).…”

Correlation between periodontal disease management and metabolic control of type 2 diabetes mellitus. A systematic literature review

“…The quality of the 13 articles was assessed using the Jadad scale ( 25 ) in order to reduce the risk of bias ( Table 1 and Table 1 continue ). None of the studies reviewed ( 26 - 38 ) had considered their level of quality, although a systematic review by Mauri et al ( 39 ) did apply the same criterion to the articles analyzed. The Jadad scale awards a maximum score of 5.…”