title: The effect of antimicrobial periodontal treatment on circulating tumor necrosis factor-alpha and glycated hemoglobin level in patients with type 2 diabetes.
abstract: BACKGROUND
  Tumor necrosis factor-alpha (TNF-alpha) may play an important role in insulin resistance. In this study, we hypothesized that TNF-alpha produced due to periodontal inflammation synergistically affects insulin resistance as well as TNF-alpha produced from adipose tissues in insulin-resistant type 2 diabetes patients. Therefore, to understand the effects of antimicrobial periodontal therapy on serum TNF-alpha concentration and subsequent metabolic control of diabetes, we examined the periodontal and diabetic status on 13 type-2 diabetes patients.
  
  
  METHODS
  These patients were treated with local minocycline administration in every periodontal pocket around all existing teeth once a week for a month. Before and after treatment, the number of total bacteria in the periodontal pockets and circulating TNF-alpha concentration were measured and the HbA1c value was assessed.
  
  
  RESULTS
  Antimicrobial therapy significantly reduced the number of microorganisms in periodontal pockets (P <0.01). After treatment, the circulating TNF-alpha level was significantly reduced (P <0.015). The HbA1c value was also reduced significantly (P <0.007). In addition, the 6 patients who were not receiving insulin therapy demonstrated decreased fasting insulin levels (P <0.03), and HOMA-R (P <0.03) indices. The average reductions in circulating TNF-alpha concentration and HbA1c value were 0.49 pg/ml and 0.8%, respectively.
  
  
  CONCLUSIONS
  The results indicate that anti-infectious treatment is effective in improving metabolic control in diabetics, possibly through reduced serum TNF-alpha and improved insulin resistance.
authors.affiliation: Department of Periodontology and Endodontology, Okayama University Dental School, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Iwamoto
authors.forename: F
authors.initials: F
authors.lastname: Nishimura
authors.forename: M
authors.initials: M
authors.lastname: Nakagawa
authors.forename: H
authors.initials: H
authors.lastname: Sugimoto
authors.forename: K
authors.initials: K
authors.lastname: Shikata
authors.forename: H
authors.initials: H
authors.lastname: Makino
authors.forename: T
authors.initials: T
authors.lastname: Fukuda
authors.forename: T
authors.initials: T
authors.lastname: Tsuji
authors.forename: M
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Y
authors.initials: Y
authors.lastname: Murayama
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D003773:Dental Plaque / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage / Q000627:therapeutic use*; D010510:Periodontal Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000188:drug therapy; D010518:Periodontitis / Q000188:drug therapy; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D000900:Anti-Bacterial Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; D008911:Minocycline; D014409:Tumor Necrosis Factor-alpha