Improvement of glycemic control after periodontal treatment by resolving gingival inflammation in type 2 diabetic patients with periodontal disease

Abstract

Aims/Introduction: Chronic inflammation aggravates glycemic control in patients with type 2 diabetes mellitus. An increase or decrease in the release and activities of various inflammatory mediators, such as tumor necrosis factor (TNF)‐α, interleukin (IL)‐6, and C‐reactive protein (CRP), are presumed to be responsible for inducing insulin resistance. The purpose of the present study was to examine the effects of non‐surgical periodontal treatment incorporating topical antibiotics on glycemic control and serum inflammatory mediators in patients with type 2 diabetes mellitus with periodontitis.Materials and Methods: Periodontal inflammation and periodontal tissue destruction were evaluated by bleeding on probing (BOP) and the probing pocket depth (PPD), respectively. A total of 41 patients with type 2 diabetes and periodontitis received periodontal treatment with the topical application of antibiotics four times within a 2‐month period. A periodontal examination, including PPD and BOP, and venous blood sampling were carried out at baseline and at 2 and 6 months after periodontal treatment. Glycated hemoglobin (HbA1c), and serum levels of high‐sensitivity (hs)‐CRP, TNF‐α and IL‐6 were analyzed.Results: A generalized linear model showed significant associations between the change in the HbA1c values at 6 months after periodontal treatment, and the change in the BOP, baseline TNF‐α levels and the baseline mean PPD.Conclusions: As BOP is a marker of total gingival inflammation, these results suggest that non‐surgical periodontal therapy with topical antibiotics in patients with mild periodontitis might improve glycemic control by resolving periodontal inflammation. Such treatments might be insufficient for the amelioration of insulin resistance in type 2 diabetic patients with severe periodontitis. This trial was registered with the University Hospital Medical Information Network (no. UMIN000006693). (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2012.00209.x, 2012)

Periodontitis and type II diabetes: a two-way relationship

“…[143][144][145][146] More recent evaluation of 41 subjects with type II diabetes and periodontitis suggests that nonsurgical periodontal treatment plus adjunctive topical minocycline may result in improved glycaemic control at 6 months in patients with mild periodontitis and high baseline TNF-α levels. 147 However, this study did not have a control group to allow comparison with untreated periodontitis. Indeed, it has been highlighted that many of the published studies that investigated the effects of periodontal treatment on glycaemic control are uncontrolled or underpowered.…”

“…Early intervention studies investigated the effects of non‐surgical periodontal therapy on glycaemic control in types I and II diabetes . More recent evaluation of 41 subjects with type II diabetes and periodontitis suggests that non‐surgical periodontal treatment plus adjunctive topical minocycline may result in improved glycaemic control at 6 months in patients with mild periodontitis and high baseline TNF‐α levels . However, this study did not have a control group to allow comparison with untreated periodontitis.…”

Chemerin as a Novel Crevicular Fluid Marker of Patients With Periodontitis and Type 2 Diabetes Mellitus

“…It is thought that periodontitis makes it harder for the body to manage DM, but that periodontal treatments can result in healthier glycemic control. Research on the impact of non‐surgical periodontal treatments for those who suffer with DM indicates a healthier periodontal condition and improvements to glycemic regulation 6–8 …”

“…Research on the impact of nonsurgical periodontal treatments for those who suffer with DM indicates a healthier periodontal condition and improvements to glycemic regulation. [6][7][8] Periodontitis and DM seem to share a number of pathogenic features. For instance, they both present increased immuno-inflammatory responses with similar biologic mediators.…”

Efeitos clínicos e metabólicos da terapia periodontal não cirúrgica em pacientes diabéticos e não diábeticos - revisão de literatura

“…10,21,29 Os autores relatam reduções na glicemia e hemoglobina glicosilada, após o uso da minociclina gel, além de melhora dos parâmentos clínicos periodontais, redução da profundidade de sondagem e ganhos nos níveis clínicos de inserção. No entanto, o uso de antibióticos tópicos apresentam vantagens e limitações em relação ao uso dos antibióticos sistêmicos; vantagens atingem a microbiota residente no interior da bolsa, mantêm concentração da droga no sítio, menor risco de reação adversa, reduz o risco de resistência bacteriana e limitações dificuldade de aplicação em bolsas profundas e áreas de bifurcação e pequeno campo de ação da droga.…”