Glycemic control and adipokines after periodontal therapy in patients with Type 2 diabetes and chronic periodontitis

Abstract

Abstract:The mechanism by which chronic periodontitis (CP) affects type 2 diabetes (T2DM) remains unclear. Therefore, the aim of this study is to evaluate the effects of periodontal therapy (PT) on the glycemic control and adipokines of patients with T2DM and CP with the purpose of elucidating the possible mechanisms by which CP influences T2DM. Forty-four patients with T2DM and CP were randomly divided into two groups according to whether they underwent PT. Periodontal status, blood glucose, and the levels of serum tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), adiponectin (APN), and fibroblast growth factor-21 (FGF-21) were measured at baseline and after 3 months. The results revealed that the probing depth (PD) and attachment loss (AL) were significantly improved, the serum levels of TNF-α and IL-6 were significantly decreased, and APN and FGF-21 exhibited substantial increases in the intervention group after 3 months (p < 0.05), whereas no significant changes were observed in the control group. The glycated hemoglobin (HbA1c) levels in both groups decreased significantly after 3 months compared with baseline (p < 0.05), but the intervention group exhibited a significantly greater change (p < 0.05). In conclusion, PT may relieve periodontal inflammation, which causes a reduction of insulin-antagonizing adipokines and an increase in insulin-sensitizing adipokines, thereby eliciting an improvement in glycemic control.

Effectiveness of the Oral Care Program&nbsp;in Type 2 Diabetic Elderly Patients with Periodontitis:&nbsp;A Clustered Randomised&nbsp;Controlled Study With 6-month Follow-Up

“…However, the reduction of HbA1c level did not meet the target of American Diabetes Association treatment goal that the HbA1c level must be reduced to less than 7.5 in healthy older people 12 . In other previous studies [24][25][26][27] , periodontal therapy in diabetic patients could signi cantly reduce HbA1c levels from 0.29-0.64% in 3-month and 0.2% in 6-month after completion of the therapy 28 . As the combination of lifestyle changes and dental care program also decreased HbA1c (0.29%) after 3-months follow-ups, whereas the HbA1c increased 0.09% in the control group 19 .…”

Possible role of gingival crevicular fluid levels of Chemerin and Fibroblast growth factor 21 as biomarkers of periodontal disease in diabetic and non-diabetic patients. A diagnostic accuracy study

“…Sample size calculation was done based on the previous papers by Wang et al,2017 andŠimják et al,2018; that reported the difference in FGF-21 level between diabetic patients with periodontitis and healthy controls to be 100±70 pg/mL. 14 patients were needed to detect that difference using power 95% and 5% significance level.…”

Effect of non-surgical periodontal treatment on crevicular levels of Chemerin and Fibroblast growth factor 21 in controlled type 2 diabetic and non-diabetic patients both with periodontitis and their glycemic control. A clinical trial

“…On the other hand, Teshome and Yitayeh, (2016) performed a meta-analysis, and the results revealed a statistically significant HbA1c reduction of 0.48 (95% CI: 0.18, 0.78) in the treatment group when compared with the control group. Similarly, Wang et al, (2017) showed that the intervention group showed a significantly greater change in the HbA1c level, which indicated that periodontal treatment, may improve the glycemic control. Accordingly, whether periodontal therapy reduces the HbA1c level in periodontitis patients still remain controversial.…”

“…However, even after treatment, FGF21 level showed a significantly higher values in the diabetic group than the non-diabetic periodontitis group. Conversely, a study performed by Wang et al, (2017) found that the serum FGF21 levels was significantly increased after therapy, which indicated that the effective control of inflammation by periodontal therapy may contribute to increasing systemic insulin-sensitizing adipokines, such as FGF21, thus in turn improving the overall health status. This discrepancy might be explained that, in the current study, the increase in crevicular FGF21 before treatment might act as a protective mechanism to oppose periodontal inflammation and as the inflammation subsided after treatment, the need for such protection is receded.…”

“…3 HbA1c level did not correlate with any of the clinical parameters (PI, GI, PD, and CAL) either before or after the treatment in periodontitis patients with diabetes. Table 6 DISCUSSION Although the association between T2DM and periodontitis has been extensively discussed, the mechanism by which periodontitis affects T2DM remains obscure (Wang et al, 2017). One of the most common and important causes of DM is dyslipidemia and an argument was raised that periodontitis may play a role in facilitation of its development within diabetics (Preshaw et al, 2012, Coimbra et al, 2014.…”