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Nonsurgical periodontal therapy failed to improve HbA1c
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Scaling and root planing plus chlorhexidine oral rinse did not improve HbA1c levels in patients with type 2 diabetes and chronic periodontitis, according to data in a recent JAMA study.
“The [Diabetes and Periodontal Therapy Trial] is to our knowledge the largest multicenter randomized clinical trial to investigate the effect of periodontal therapy on measures of glycemic control in patients with type 2 diabetes and chronic periodontitis,” Steven P. Engebretson, DMD, of New York University College of Dentistry, and colleagues wrote. “Despite its effectiveness in improving clinical measures of periodontitis, periodontal therapy did not significantly change HbA1c levels after 3 or 6 months in the treatment group, and no differences in changes in HbA1c levels were observed between the treatment and control groups.”
The Diabetes and Periodontal Therapy Trial (DPTT) was a 6-month, single-masked, multicenter, randomized clinical trial in which the participants were older than 35 years with type 2 diabetes, taking stable doses of medications, HbA1c levels >7% and <9%, and untreated chronic periodontitis.
The study included 514 participants enrolled between November 2009 and March 2012 from diabetes and dental clinics, as well as communities affiliated with five academic medical centers.
The treatment group (n=257) received at least 160 minutes of scaling and root planning in addition to chlorhexidine oral rinse within 42 days of baseline. They also underwent additional periodontal therapy at 3 and 6 months. The control group (n=257) received no treatment for the duration of the 6 months, at which time enrollment was halted early due to futility.
At 6 months, the primary endpoint of mean HbA1c reduction was not achieved. HbA1c levels in the therapy group increased 0.17% vs. 0.11% in the control group (mean difference, –0.05%; 95% CI, −0.23 to 0.12).
Secondary periodontal endpoints improved in the treatment group compared with the control group at 6 months, with adjusted between-group differences of 0.28 mm (95% CI, 0.18-0.37) for probing depth; 0.25 mm (95% CI, 0.14-0.36) for clinical attachment loss; 13.1% (95% CI, 8.1-18.1) for bleeding on probing; and 0.27 (95% CI, 0.17-0.37) for gingival index.
“Although probing depths and clinical attachment levels were significantly improved in the treatment group, improvements in plaque and bleeding scores were only modest and indicate that changing oral hygiene habits remains a challenge,” the researchers wrote.
Disclosure: This study was funded through cooperative agreement grants U01 DE018902 and U01 DE018886 from the National Institute of Dental and Craniofacial Research, National Institutes of Health. Please see the study for a full list of researchers’ financial disclosures.
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