title: Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta-analysis.
abstract: BACKGROUND
  The effect of periodontal therapy on diabetes outcomes has not been established.
  
  
  OBJECTIVE
  This update examines the effect of periodontal treatment on diabetes outcomes.
  
  
  METHODS
  Literature since October 2009 using MEDLINE.
  
  
  METHODS
  Published RCTs including periodontal therapy for diabetic subjects, a metabolic outcome, an untreated control group, and follow-up of 3 months.
  
  
  METHODS
  Pre-defined data fields, including study quality indicators were used.
  
  
  RESULTS
  A search revealed 56 publications of which 9 met inclusion criteria. Mean change of HbA1c from baseline was compared across treatment groups. Pooled analysis was based on random effects models.
  
  
  RESULTS
  A meta-analysis indicated a mean treatment effect of _0.36% HbA1c (CI _0.54, _0.19) compared to no treatment after periodontal therapy (p < 0.0001). Heterogeneity tests revealed only minimal evidence of publication bias (I2 = 9%).
  
  
  CONCLUSIONS
  Small sample size and high risk of bias remain problematic for studies of this type. Periodontal therapy varied considerably.
  
  
  CONCLUSIONS
  The modest reduction in HbA1c observed as a result of periodontal therapy in subjects with type 2 diabetes is consistent with previous systematic reviews. Despite this finding, there is limited confidence in the conclusion due to a lack of multi-centre trials of sufficient sample size are lacking.
authors: Department of Periodontology and Implant Dentistry, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA. spe2002@nyu.edu
authors: Steven
authors: S
authors: Engebretson
authors: Thomas
authors: T
authors: Kocher
mesh_terms: D003924:Diabetes Mellitus, Type 2; D006801:Humans
references: J Clin Periodontol. 1993 Mar;20(3):161-5
references: 8450080
references: J Clin Periodontol. 2011 Feb;38(2):142-7
references: 21114680
references: Ann Periodontol. 1996 Nov;1(1):821-78
references: 9118282
references: Intern Med. 2011;50(15):1569-74
references: 21804283
references: Oral Dis. 2005 Sep;11(5):293-8
references: 16120115
references: J Periodontol. 1996 Oct;67(10 Suppl):1085-93
references: 8910827
references: N Engl J Med. 1997 Aug 21;337(8):536-42
references: 9262498
references: Pharmacol Res. 2011 Dec;64(6):624-9
references: 21782948
references: J Periodontol. 2000 Apr;71(4):521-32
references: 10807113
references: N Engl J Med. 2002 Feb 7;346(6):393-403
references: 11832527
references: Diabetes Care. 2010 Feb;33(2):421-7
references: 20103557
references: Ann Intern Med. 2001 May 1;134(9 Pt 1):737-45
references: 11329231
references: Diabetes Care. 2012 Oct;35(10):2036-42
references: 22855731
references: N Engl J Med. 1993 Sep 30;329(14):977-86
references: 8366922
references: Diabetes Res Clin Pract. 2008 Feb;79(2):196-203
references: 17931733
references: Ann Intern Med. 2004 Sep 21;141(6):421-31
references: 15381515
references: Stat Med. 2002 Jun 15;21(11):1539-58
references: 12111919
references: Lancet. 2011 Jul 2;378(9785):31-40
references: 21705069
references: Diabetologia. 2009 Jan;52(1):17-30
references: 18941734
references: Diabetes Res Clin Pract. 2009 Mar;83(3):308-15
references: 19168253
references: BMJ. 2000 Jun 10;320(7249):1574-7
references: 10845965
references: Folia Med (Plovdiv). 2007;49(1-2):32-6
references: 18018467
references: Clin Ther. 2011 Jan;33(1):74-109
references: 21397776
references: Diabetes Care. 1997 May;20(5):785-91
references: 9135943
references: Aust Dent J. 2012 Mar;57(1):31-7
references: 22369555
references: Lancet. 1998 Sep 12;352(9131):837-53
references: 9742976
references: Community Dent Oral Epidemiol. 2002 Jun;30(3):182-92
references: 12000341
references: Arch Oral Biol. 2010 Dec;55(12):970-4
references: 20889139
references: J Periodontol. 1989 Sep;60(9):485-90
references: 2677301
references: J Clin Periodontol. 2007 Jan;34(1):46-52
references: 17137468
references: J Intern Med. 1989 Jan;225(1):15-9
references: 2645379
references: Ann Intern Med. 2010 Mar 16;152(6):346-57
references: 20231565
references: J Periodontol. 2012 Apr;83(4):435-43
references: 21859323
references: Cochrane Database Syst Rev. 2010 May 12;(5):CD004714
references: 20464734
references: Ann Intern Med. 1998 Feb 1;128(3):176-85
references: 9454525
references: Popul Health Manag. 2009 Apr;12(2):95-101
references: 19361252
references: J Clin Periodontol. 2001 Apr;28(4):306-10
references: 11314885
references: J Dent Res. 2005 Dec;84(12):1154-9
references: 16304446
references: Ann Periodontol. 2001 Dec;6(1):99-112
references: 11887478
references: J Clin Periodontol. 1990 Aug;17(7 Pt 1):467-71
references: 2403413
references: J Clin Periodontol. 2005 Mar;32(3):266-72
references: 15766369
references: Int J Diabetes Dev Ctries. 2008 Apr;28(2):38-44
references: 19902046
references: J Clin Invest. 2006 Jul;116(7):1793-801
references: 16823477
references: Diabetes Care. 2003 Jan;26 Suppl 1:S5-20
references: 12502614
references: J Clin Periodontol. 2008 Dec;35(12):1011-2
references: 19040576
references: Periodontol 2000. 2009;51:252-68
references: 19878479
references: J Clin Invest. 2002 May;109(10):1321-6
references: 12021247
references: Obes Res Clin Pract. 2013 Mar-Apr;7(2):e129-e138
references: 24331774
references: J Clin Periodontol. 2009 Feb;36(2):114-23
references: 19207886