Systematic review and assessment of systematic reviews examining the effect of periodontal treatment on glycemic control in patients with diabete

Abstract

ObjetivesThere have been several systematic reviews(SRs) on whether periodontal treatment for an individual with both periodontal disease and diabetes can improve diabetes outcomes. The purpose of this investigation was to conduct a systematic review (SR) of previous meta-analyses, and to assess the methodological quality of the SRs examining the effects of periodontal treatment and diabetes. (PROSPERO Registration # CRD 42015023470).Study DesignWe searched five electronic databases and identified previous meta-analyses of randomized controlled trials published through July 2015. In cases where the meta-analysis did not meet our criteria, the meta-analyses were recalculated. General characteristics of each included trial were abstracted, analyzed, and compared. The mean difference, 95% confidence intervals (CIs) and the I2 statistic were abstracted or recalculated. The Assessment of Multiple Systematic Reviews Instrument (AMSTAR) was used to assess methodological quality.ResultsOf the 475 citations screened, nine systematic reviews were included. In total, 13 meta-analyses included in nine SRs were examined. In comparability analyses, meta-analyses in four SRs did not meet our criteria, and were recalcuated. Of these 13 meta-analyses, 10 suggested significant effects of periodontal treatment on HbA1c improvement. Mean differences found in the 13 meta-analyses ranged from -0.93 to 0.13. AMSTAR assessment revealed six SRs with moderate and three with high overall quality.ConclusionsWe can conclude that there is a significant effect of periodontal treatment on improvement of HbA1c in diabetes patients, although the effect size is extremely small. In addition to the small effect size, not all SRs could be considered of high quality. Key words:Periodontal treatment, diabetes, HbA1c, systematic review, systematic review of systematic reviews, evidence-based medicine, AMSTAR.

An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes

“…The systematic review of systematic reviews by Hasuike et al. () included systematic reviews published in five libraries from 1955! (web of science) to 25 July 2015 (PubMed, Cochrane database, Trip database, web of science).…”

“…Data derived from this update, which is a review of the meta-analyses and systematic reviews that evaluate the effect of periodontal therapy (with or without the adjunct use of antibiotics) on the glycaemic control of people with types 1 or 2 diabetes mellitus (DM) published between 2013 and 2017, are in accordance with earlier data. During the last two years, three studies with the aim to evaluate available meta-analyses and systematic reviews on the same subject have been published (Botero, Rodrıguez, & Agudelo-Suarez, 2016;Faggion, Cullinan, &Atieh, 2016 andHasuike, Iguchi, Suzuki, Kawano, &Sato, 2017) (Table 4). The Faggion et al (2016) review includes 11 systematic reviews up to March 2015, eight of which include only RCTs and the remaining three also non-RCTs.…”

Methodological quality and risk‐of‐bias assessments in systematic reviews of treatments for peri‐implantitis

“…Several studies have demonstrated quality assessments in SRs regarding periodontal treatment and dental implant treatments . Ting et al conducted a comprehensive overview of SRs regarding peri‐implantitis focusing on not only treatments, but also prevalence, etiology, and diagnosis.…”

IDF Diabetes Atlas: Diabetes and oral health – A two-way relationship of clinical importance

“…An abundance of studies around the world -some of which admittedly are small and some have bias -report that non-surgical periodontal treatment reduces HbA1c levels in type 2 diabetes. Findings from various subsets of these studies are synthesized in systematic reviews and in umbrella reviews of such systematic reviews, the most recent of which find non-surgical periodontal treatment to reduce the HbA1c level 3 months post-treatment by the following percentage points: 0.23-1.03% [89], mean 0.48% [90], mean 0.46% (median 0.40%) [91], and between 0.93% reduction and 0.13% increase [92]. An overview of the results of these systematic reviews and meta-analyses is provided in ''Diabetes in America, 3rd edition" published by the US federal government (Table 31.2, page 31-13) [24].…”