Improved oral health could help glycemic control in type 2 diabetes
medwireNews: A year of intensive periodontal treatment is associated with a significant reduction in glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes and moderate-to-severe periodontitis, UK researchers report.
Writing in The Lancet Diabetes & Endocrinology, Francesco D’Aiuto, from University College London, and colleagues say their findings “suggest that oral health improvement in this population represents a novel and important therapeutic opportunity.”
At baseline, mean HbA1c was 8.1% in the 264 patients included in the study.
After 12 months of intensive periodontal treatment, the unadjusted mean HbA1c was 7.8% in the 133 patients randomly assigned to this group. Intensive treatment included initial whole mouth subgingival scaling and surgical periodontal therapy at 2 months (for patients with good oral hygiene practice; otherwise dental cleaning again), as well as supportive periodontal therapy every 3 months until the end of the study.
By comparison, unadjusted mean HbA1c was 8.3% at 12 months in the 131 patients randomly assigned to receive control treatment, namely supra-gingival scaling and polishing at the same intervals as the intensive group.
When the researchers took baseline HbA1c, age, sex, ethnicity, smoking status, duration of diabetes, and BMI into account they found that, at 12 months, mean HbA1c was a significant 0.6% lower in the intensive treatment group than in the control group.
In an accompanying commentary, Pirkko Pussinen (University of Helsinki, Finland) and Veikko Salomaa (National Institute for Health and Welfare, Helsinki) point out that this magnitude of decrease in HbA1c is “roughly equal to that of an additional glucose-lowering drug.”
Furthermore, post-hoc analyses showed that 65% of patients in the intensive group achieved a 0.4% reduction in HbA1c levels at 12 months and 67% achieved a 0.9% reduction, compared with a significantly lower 36% and 33% of patients, respectively, in the control group.
Fasting plasma glucose, C-reactive protein and tumor necrosis factor alpha concentrations, creatinine levels, and 10-year cardiovascular risk scores were also significantly lower after 12 months of intensive therapy compared with control therapy, while estimated glomerular filtration rate was significantly higher.
In addition, patients in the intensive treatment group reported better quality of life at the end of the study than those in the control group, which was mainly due to improved working life, self-confidence, and living conditions.
D’Aiuto et al conclude that their “findings support the hypothesis that reduction of periodontal inflammation is associated with reduced systemic inflammation and improved vascular function and metabolic markers.”
And Pussinen and Salomaa say that the “impressive” results “could suggest protective effects from both microvascular and macrovascular complications, which are important causes of morbidity and mortality in people with diabetes.”
They continue: “Hopefully follow-up of these patients will continue–or other longer-term studies will be done–in order to confirm the beneficial effects of intensive treatment of periodontitis in people with diabetes.”
By Laura Cowen
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