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- Title
The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial.
- Authors
Engebretson, Steven P; Hyman, Leslie G; Michalowicz, Bryan S; Schoenfeld, Elinor R; Gelato, Marie C; Hou, Wei; Seaquist, Elizabeth R; Reddy, Michael S; Lewis, Cora E; Oates, Thomas W; Tripathy, Devjit; Katancik, James A; Orlander, Philip R; Paquette, David W; Hanson, Naomi Q; Tsai, Michael Y
- Abstract
<bold>Importance: </bold>Chronic periodontitis, a destructive inflammatory disorder of the supporting structures of the teeth, is prevalent in patients with diabetes. Limited evidence suggests that periodontal therapy may improve glycemic control.<bold>Objective: </bold>To determine if nonsurgical periodontal treatment reduces levels of glycated hemoglobin (HbA1c) in persons with type 2 diabetes and moderate to advanced chronic periodontitis.<bold>Design, Setting, and Participants: </bold>The Diabetes and Periodontal Therapy Trial (DPTT), a 6-month, single-masked, multicenter, randomized clinical trial. Participants had type 2 diabetes, were taking stable doses of medications, had HbA1c levels between 7% and less than 9%, and untreated chronic periodontitis. Five hundred fourteen participants were enrolled between November 2009 and March 2012 from diabetes and dental clinics and communities affiliated with 5 academic medical centers.<bold>Interventions: </bold>The treatment group (n = 257) received scaling and root planing plus chlorhexidine oral rinse at baseline and supportive periodontal therapy at 3 and 6 months. The control group (n = 257) received no treatment for 6 months.<bold>Main Outcomes and Measures: </bold>Difference in change in HbA1c level from baseline between groups at 6 months. Secondary outcomes included changes in probing pocket depths, clinical attachment loss, bleeding on probing, gingival index, fasting glucose level, and Homeostasis Model Assessment (HOMA2) score.<bold>Results: </bold>Enrollment was stopped early because of futility. At 6 months, mean HbA1c levels in the periodontal therapy group increased 0.17% (SD, 1.0), compared with 0.11% (SD, 1.0) in the control group, with no significant difference between groups based on a linear regression model adjusting for clinical site (mean difference, -0.05% [95% CI, -0.23% to 0.12%]; P = .55). Periodontal measures 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 to 0.37) for probing depth, 0.25 mm (95% CI, 0.14 to 0.36) for clinical attachment loss, 13.1% (95% CI, 8.1% to 18.1%) for bleeding on probing, and 0.27 (95% CI, 0.17 to 0.37) for gingival index (P < .001 for all).<bold>Conclusions and Relevance: </bold>Nonsurgical periodontal therapy did not improve glycemic control in patients with type 2 diabetes and moderate to advanced chronic periodontitis. These findings do not support the use of nonsurgical periodontal treatment in patients with diabetes for the purpose of lowering levels of HbA1c.<bold>Trial Registration: </bold>clinicaltrials.gov Identifier: NCT00997178.
- Subjects
CHRONIC disease treatment; DIABETES complications; PERIODONTITIS treatment; TYPE 2 diabetes complications; BLOOD sugar; CHLORHEXIDINE; CHRONIC diseases; DENTAL scaling; GLYCOSYLATED hemoglobin; MOUTHWASHES; TYPE 2 diabetes; PERIODONTITIS; RESEARCH funding; TOOTH root planing; TREATMENT effectiveness; BLIND experiment; DISEASE complications
- Publication
JAMA: Journal of the American Medical Association, 2013, Vol 310, Issue 23, p2523
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2013.282431