Effect of periodontal treatment on glycemic control of patients with diabetes: A systematic review and meta-analysis

Stefano Corbella, Luca Francetti, Silvio Taschieri, Francesca De Siena, Massimo Del Fabbro, Stefano Corbella, Luca Francetti, Silvio Taschieri, Francesca De Siena, Massimo Del Fabbro

Abstract

Aims/introduction: The aim of the present study was to investigate whether non-surgical periodontal treatment reduces glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels in diabetic patients.

Materials and methods: An electronic search was carried out on MEDLINE (through PubMed interface), EMBASE and the Cochrane Central Register of Controlled Trials. Randomized controlled trials with a minimum of 3 months follow up were included. The risk of bias was assessed for each study. A meta-analysis was carried out to evaluate the effect of non-surgical periodontal treatment on HbA1c and FPG levels. The effect of the adjunctive use of antimicrobials was also assessed.

Results: A total of 15 studies were included. A reduction of -0.38% (95% confidence interval [CI] -0.23 to -0.53) after 3-4 months (P < 0.001) and of -0.31% (95% CI 0.11 to -0.74) after 6 months (P = 0.15) of follow-up was found for HbA1c, favoring the treatment group. Similarly, in treated patients, a significantly greater decrease in FPG was observed in respect to control participants. Such difference amounted to -9.01 mg/dL (95% CI -2.24 to -15.78) after 3-4 months (P = 0.009) and -13.62 mg/dL (95% CI 0.45 to -27.69) after 6 months (P = 0.06) from treatment, respectively. In participants treated with adjunctive antimicrobials, a non-significant increase of HbA1c was observed 3 months after treatment, whereas FPG decreased by 0.27 mg/dL (95% CI 39.56 to -40.11; P = 0.99).

Conclusions: The meta-analysis showed that non-surgical periodontal treatment improves metabolic control in patients with both periodontitis and diabetes.

Keywords: Diabetes; Metabolic control; Periodontal diseases.

Figures

Figure 1
Figure 1
Flow chart of article selection process.
Figure 2
Figure 2
Risk of bias evaluation graph.
Figure 3
Figure 3
Non‐surgical periodontal treatment vs no treatment: 3‐month glycated hemoglobin (%) difference between baseline and end of treatment. CI, confidence interval; df, degrees of freedom; SD, standard deviation.
Figure 4
Figure 4
Non‐surgical periodontal treatment vs no treatment: 6‐month glycated hemoglobin (%) difference between baseline and end of treatment. CI, confidence interval; df, degrees of freedom; SD, standard deviation.
Figure 5
Figure 5
Non‐surgical periodontal treatment and adjunctive antimicrobials vs non‐surgical periodontal treatment: 3‐month glycated hemoglobin (%) difference between baseline and end of treatment. Study heterogeneity cannot be observed (P = 0.47). CI, confidence interval; df, degrees of freedom; SD, standard deviation.
Figure 6
Figure 6
Non‐surgical periodontal treatment vs no treatment: 3‐month fasting plasma glucose (mg/dL) difference between baseline and end of treatment. CI, confidence interval; df, degrees of freedom; SD, standard deviation.
Figure 7
Figure 7
Non‐surgical periodontal treatment vs no treatment: 6‐month glycated hemoglobin (%) difference between baseline and end of treatment. Study heterogeneity cannot be observed (P = 0.50). CI, confidence interval; df, degrees of freedom; SD, standard deviation.
Figure 8
Figure 8
Non‐surgical periodontal treatment and adjunctive vs Non‐surgical periodontal treatment: 3‐month fasting plasma glucose (mg/dL) difference between baseline and end of treatment. Study heterogeneity cannot be observed (P = 0.46). CI, confidence interval; df, degrees of freedom; SD, standard deviation.

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