title: Improvement of glycated hemoglobin in Japanese subjects with type 2 diabetes by resolution of periodontal inflammation using adjunct topical antibiotics: results from the Hiroshima Study.
abstract: OBJECTIVE
  Periodontal treatment reduces glycated hemoglobin (HbA1) in subjects with type 2 diabetes, although effective strategy for different severities of periodontitis remains unclear. We hypothesized that resolution of periodontitis-induced inflammation by the therapy combined with antibiotics may have beneficial effects on the glycemic control of diabetes.
  
  
  METHODS
  A total of 523 subjects with type 2 diabetes were screened for periodontal disease. Of these, 160 subjects who visited dentists were divided into two groups according to high-sensitivity c-reactive protein (hsCRP) level: >500 ng/ml and <500 ng/ml. The group with hsCRP over 500 ng/ml was further sub-divided into two groups according to treatment strategy: topical application of antibiotics combined with conventional mechanical debridement (group A), and debridement alone (B). Subjects with hsCRP below 500 ng/ml were sub-divided similarly (C: combination therapy; D: debridement alone). hsCRP was measured after 1 month and changes of HbA1c after 3 months. These parameters were also measured in control subjects (N=118) who did not visit dentists (E: initial hsCRP>500 ng/ml; F: hsCRP<500 ng/ml).
  
  
  RESULTS
  A multiple comparison by ANOVA revealed that only group A showed a significant reduction in HbA1c over time (P<0.001). Multivariable analyses revealed elevated hsCRP and the combination treatment with antibiotics were two independent variables influencing the decrease of HbA1c over the study (P<0.01 and P<0.001, respectively).
  
  
  CONCLUSIONS
  In subjects with type 2 diabetes and periodontitis-induced mild inflammation (hsCRP>500 ng/ml), treatment to reduce hsCRP using antibiotics is recommended.
authors: Hiroshima Prefectural Dental Association, Hiroshima, Japan.
authors: Yasuichi
authors: Y
authors: Munenaga
authors: Toru
authors: T
authors: Yamashina
authors: Junko
authors: J
authors: Tanaka
authors: Fusanori
authors: F
authors: Nishimura
mesh_terms: D000287:Administration, Topical; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D044466:Asian People; D001786:Blood Glucose; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000187:drug effects* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000187:drug effects*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D010518:Periodontitis / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D018836:Inflammation Mediators; C517652:hemoglobin A1c protein, human