Trial finds improvement in HbA1c level with intensive periodontal treatment

Intensive treatment consisted of whole-mouth subgingival scaling, surgical periodontal therapy if patients practiced good oral hygiene or dental cleaning if they did not, and supportive periodontal therapy every three months until the end of the study.


Intensive periodontal treatment was associated with lower HbA1c values in a recent randomized trial of patients with type 2 diabetes.

Researchers in the United Kingdom recruited patients with type 2 diabetes with at least 15 teeth and moderate to severe periodontitis from local hospitals and medical or dental practices and randomly assigned them to receive intensive or control periodontal treatment. Intensive treatment consisted of whole-mouth subgingival scaling, surgical periodontal therapy if patients practiced good oral hygiene or dental cleaning if they did not, and supportive periodontal therapy every three months until the end of the study. Control treatment consisted of supragingival scaling and polishing at the same timepoints as the intensive treatment group. The study's primary outcome was between-group difference in HbA1c at 12 months. Results were published Oct. 24 by The Lancet Diabetes & Endocrinology.

Two hundred sixty-four patients were randomly assigned between Oct. 1, 2008, and Oct. 21, 2012, with 134 assigned to the intensive treatment group and 131 assigned to the control group. Most patients were men between 30 and 60 years of age, and mean HbA1c level at baseline was 8.1% in both groups. At the 12-month timepoint, the unadjusted mean HbA1c level was 8.3% in the control group and 7.8% in the intensive treatment group. After adjustment for HbA1c level at baseline, age, sex, ethnicity, smoking status, diabetes duration, and body mass index, HbA1c level was 0.6% (95% CI, 0.3% to 0.9%) lower in the intensive treatment group versus the control group (P<0.0001). Thirty patients in the intensive treatment group and 23 patients in the control group experienced at least one adverse event (23% vs. 18%). Serious adverse events occurred in 11 patients in each group, including one death in the intensive treatment group and three deaths in the control group.

The researchers noted that their findings could be due in part to the use of nondiabetes medications, such as aspirin and beta-blockers, which differed between groups at baseline. In addition, their study could have been affected by recruitment bias and their results should not be generalized to all patients with type 2 diabetes, they said. They pointed out that almost 50% of patients with diabetes have severe periodontitis and that their findings “highlight the potential to improve metabolic control and possibly diabetes outcomes by addressing poor oral health in those with diabetes.” The authors called for larger studies with longer follow-up periods to confirm their results.