The effect of periodontal treatment on hemoglobin a1c levels of diabetic patients: a systematic review and meta-analysis

Xingxing Wang, Xu Han, Xiaojing Guo, Xiaolong Luo, Dalin Wang, Xingxing Wang, Xu Han, Xiaojing Guo, Xiaolong Luo, Dalin Wang

Abstract

Background: There is growing evidence that periodontal treatment may affect glycemic control in diabetic patients. And several systematic reviews have been conducted to assess the effect of periodontal treatment on diabetes outcomes. Researches of this aspect are widely concerned, and several new controlled trials have been published. The aim of this study was to update the account for recent findings.

Methods: A literature search (until the end of January 2014) was carried out using various databases with language restriction to English. A randomized controlled trial (RCT) was selected if it investigated periodontal therapy for diabetic subjects compared with a control group received no periodontal treatment for at least 3 months of the follow-up period. The primary outcome was hemoglobin A1c (HbA1c), and secondary outcomes were periodontal parameters included probing pocket depth (PPD) and clinical attachment level (CAL).

Results: Ten trials of 1135 patients were included in the analysis. After the follow-up of 3 months, treatment substantially lowered HbA1c compared with no treatment after periodontal therapy (-0.36%, 95%CI, -0.52% to -0.19%, P<0.0001). Clinically substantial and statistically significant reduction of PPD and CAL were found between subjects with and without treatment after periodontal therapy (PPD -0.42 mm, 95%CI: -0.60 to -0.23, P<0.00001; CAL -0.34 mm, 95%CI: -0.52 to -0.16, P=0.0002). And there is no significant change of the level of HbA1c at the 6-month comparing with no treatment (-0.30%, 95%CI, -0.69% to 0.09%, P=0.13).

Conclusions: Periodontal treatment leads to the modest reduction in HbA1c along with the improvement of periodontal status in diabetic patients for 3 months, and this result is consistent with previous systematic reviews. And the effect of periodontal treatment on HbA1c cannot be observed at 6-month after treatment.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow diagram of the trials…
Figure 1. Flow diagram of the trials search and selection process.
Figure 2. Judgements about each risk of…
Figure 2. Judgements about each risk of bias item for each included study.
Figure 3. Each risk of bias item…
Figure 3. Each risk of bias item presented as percentages across all included studies.
Figure 4. Forest plot presenting change in…
Figure 4. Forest plot presenting change in HbA1c (%) at 3-month.
Figure 5. Forest plot presenting change in…
Figure 5. Forest plot presenting change in PPD (mm) at 3-month.
Figure 6. Forest plot presenting change in…
Figure 6. Forest plot presenting change in CAL (mm) at 3-month.
Figure 7. Forest plot presenting change in…
Figure 7. Forest plot presenting change in HbA1c (%) at 6-month.
Figure 8. Funnel plot presenting change in…
Figure 8. Funnel plot presenting change in HbA1c (%) at 3-month.

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