title: The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial.
abstract: OBJECTIVE
  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.
  
  
  OBJECTIVE
  To determine if nonsurgical periodontal treatment reduces levels of glycated hemoglobin (HbA1c) in persons with type 2 diabetes and moderate to advanced chronic periodontitis.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00997178.
authors.affiliation: Department of Periodontology and Implant Dentistry, New York University, New York, New York.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Engebretson
authors.affiliation: Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, New York.
authors.forename: Leslie G
authors.initials: LG
authors.lastname: Hyman
authors.affiliation: Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis.
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Michalowicz
authors.affiliation: Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, New York.
authors.forename: Elinor R
authors.initials: ER
authors.lastname: Schoenfeld
authors.affiliation: Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, New York.
authors.forename: Marie C
authors.initials: MC
authors.lastname: Gelato
authors.affiliation: Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, New York.
authors.forename: Wei
authors.initials: W
authors.lastname: Hou
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Seaquist
authors.affiliation: Department of Periodontology, University of Alabama at Birmingham.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Reddy
authors.affiliation: Department of Medicine, University of Alabama at Birmingham.
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: School of Dentistry, University of Texas at San Antonio.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Oates
authors.affiliation: Department of Medicine, University of Texas-San Antonio Health Science Center.
authors.forename: Devjit
authors.initials: D
authors.lastname: Tripathy
authors.affiliation: Department of Periodontics, University of Texas at Houston.
authors.forename: James A
authors.initials: JA
authors.lastname: Katancik
authors.affiliation: Department of Internal Medicine, University of Texas-Houston Health Science Center10Department of Endocrinology, University of Texas-Houston Health Science Center.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Orlander
authors.affiliation: Stony Brook University School of Dental Medicine, Stony Brook, New York.
authors.forename: David W
authors.initials: DW
authors.lastname: Paquette
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis.
authors.forename: Naomi Q
authors.initials: NQ
authors.lastname: Hanson
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Tsai
mesh_terms: D000368:Aged; D001786:Blood Glucose; D002710:Chlorhexidine / Q000008:administration & dosage; D055113:Chronic Periodontitis / Q000097:blood / Q000150:complications / Q000628:therapy*; D012534:Dental Scaling; D048909:Diabetes Complications / Q000097:blood / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000008:administration & dosage; D016745:Root Planing; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D002710:Chlorhexidine; D006442:Glycated Hemoglobin; D009067:Mouthwashes