1. Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial
- Author
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Nikos Donos, Devina Bhowruth, Jean Suvan, Donna Moskal-Fitzpatrick, Tauseef Khan, Aroon D. Hingorani, Francesco D'Aiuto, Dave Spratt, Ankeet Haria, Ulpee Darbar, Mohamed Parkar, Alastair Lomax, Michael Lessani, Kasia Niziolek, Riccardo Zambon, Steve Hurel, Isabel Kingston, John E. Deanfield, Kevin C.R. Baynes, Shiefung Tay, Nikos Tatarakis, Marco Orlandi, Attila Horváth, Zoe Harrington, Banbai Hirani, Tiffany Mellor, Kalpesh Patel, Maria Chiara Curra, Elaine Giedrys-Leeper, N Gkranias, Georgios Tsakos, Stefano Masi, Francis J. Hughes, David Gable, and Pratik Patel
- Subjects
Adult ,Blood Glucose ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Population ,Type 2 diabetes ,Systemic inflammation ,Root Planing ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Dental Staff ,Randomized controlled trial ,law ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Periodontitis ,education ,Glycated Hemoglobin ,education.field_of_study ,business.industry ,030206 dentistry ,Middle Aged ,Prognosis ,medicine.disease ,Clinical trial ,Diabetes Mellitus, Type 2 ,Dental Scaling ,Female ,medicine.symptom ,business ,Biomarkers ,Follow-Up Studies - Abstract
Summary Background Chronic inflammation is believed to be a major mechanism underlying the pathophysiology of type 2 diabetes. Periodontitis is a cause of systemic inflammation. We aimed to assess the effects of periodontal treatment on glycaemic control in people with type 2 diabetes. Methods In this 12 month, single-centre, parallel-group, investigator-masked, randomised trial, we recruited patients with type 2 diabetes, moderate-to-severe periodontitis, and at least 15 teeth from four local hospitals and 15 medical or dental practices in the UK. We randomly assigned patients (1:1) using a computer-generated table to receive intensive periodontal treatment (IPT; whole mouth subgingival scaling, surgical periodontal therapy [if the participants showed good oral hygiene practice; otherwise dental cleaning again], and supportive periodontal therapy every 3 months until completion of the study) or control periodontal treatment (CPT; supra-gingival scaling and polishing at the same timepoints as in the IPT group). Treatment allocation included a process of minimisation in terms of diabetes onset, smoking status, sex, and periodontitis severity. Allocation to treatment was concealed in an opaque envelope and revealed to the clinician on the day of first treatment. With the exception of dental staff who performed the treatment and clinical examinations, all study investigators were masked to group allocation. The primary outcome was between-group difference in HbA 1c at 12 months in the intention-to-treat population. This study is registered with the ISRCTN registry, number ISRCTN83229304. Findings Between Oct 1, 2008, and Oct 31, 2012, we randomly assigned 264 patients to IPT (n=133) or CPT (n=131), all of whom were included in the intention-to-treat population. At baseline, mean HbA 1c was 8·1% (SD 1·7) in both groups. After 12 months, unadjusted mean HbA 1c was 8·3% (SE 0·2) in the CPT group and 7·8% (0·2) in the IPT group; with adjustment for baseline HbA 1c , age, sex, ethnicity, smoking status, duration of diabetes, and BMI, HbA 1c was 0·6% (95% CI 0·3–0·9; p Interpretation Compared with CPT, IPT reduced HbA 1c in patients with type 2 diabetes and moderate-to-severe periodontitis after 12 months. These results suggest that routine oral health assessment and treatment of periodontitis could be important for effective management of type 2 diabetes. Funding Diabetes UK and UK National Institute for Health Research.
- Published
- 2018