Patients with type 2 diabetes who received intensive periodontal treatment had lower HbA1c levels, a British randomized controlled trial (RCT) found. The 134 intervention patients received whole-mouth subgingival scaling, surgical periodontal therapy if they practiced good oral hygiene or dental cleaning if they did not, and supportive periodontal therapy every three months until the end of the study, while 131 controls got supragingival scaling and polishing at the same timepoints as the intensive treatment group. At one year, adjusted HbA1c levels were 0.6% lower in the intervention group.
The study was published by The Lancet Diabetes & Endocrinology on Oct. 24, 2018, and summarized in the November 2018 ACP Diabetes Monthly. The following commentary by Zubin Punthakee, MD, was published in the ACP Journal Club section of the April 16 Annals of Internal Medicine.
Strategies to achieve glycemic targets in patients with type 2 diabetes, beyond the typical drugs, diet, and exercise, would be welcome. The well-designed, but small (by diabetes trial standards), RCT by D’Aiuto and colleagues showed that intensive periodontal care can improve glycemic control over 1 year in patients with type 2 diabetes and moderate-to-severe periodontitis. The degree of glycemic improvement was on the order of second-line glucose-lowering drugs.
The trial adds to a body of literature documenting short-term glycemic benefits of periodontal treatment, with 15 RCTs showing a mean HbA1c reduction of 0.29% at 3 to 4 months but 5 RCTs showing no effect at 6 months. It remains to be seen whether the benefits of intensive periodontal care are reproducible in other centers, are durable, and reduce diabetes complications.
Good oral health for people with diabetes has been recommended since 2009 by the International Diabetes Federation. As evidence builds, periodontal care may make its way into major evidence-based guidelines and support a change in practice. This will bring challenges, including incorporating dental professionals into diabetes care teams (especially in jurisdictions where access is limited by financial barriers) and training doctors, nurses, and dietitians who treat patients with diabetes to recognize and assess periodontal disease and make appropriate referrals.