Improvement of glycemic control after periodontal treatment by resolving gingival inflammation in type 2 diabetic patients with periodontal disease.
Aims/Introduction:  Chronic inflammation aggravates glycemic control in patients with type 2 diabetes mellitus. An increase or decrease in the release and activities of various inflammatory mediators, such as tumor necrosis factor (TNF)-α, interleukin (IL)-6, and C-reactive protein (CRP), are presumed to be responsible for inducing insulin resistance. The purpose of the present study was to examine the effects of non-surgical periodontal treatment incorporating topical antibiotics on glycemic control and serum inflammatory mediators in patients with type 2 diabetes mellitus with periodontitis.


METHODS
Periodontal inflammation and periodontal tissue destruction were evaluated by bleeding on probing (BOP) and the probing pocket depth (PPD), respectively. A total of 41 patients with type 2 diabetes and periodontitis received periodontal treatment with the topical application of antibiotics four times within a 2-month period. A periodontal examination, including PPD and BOP, and venous blood sampling were carried out at baseline and at 2 and 6 months after periodontal treatment. Glycated hemoglobin (HbA1c), and serum levels of high-sensitivity (hs)-CRP, TNF-α and IL-6 were analyzed.


RESULTS
A generalized linear model showed significant associations between the change in the HbA1c values at 6 months after periodontal treatment, and the change in the BOP, baseline TNF-α levels and the baseline mean PPD.


CONCLUSIONS
As BOP is a marker of total gingival inflammation, these results suggest that non-surgical periodontal therapy with topical antibiotics in patients with mild periodontitis might improve glycemic control by resolving periodontal inflammation. Such treatments might be insufficient for the amelioration of insulin resistance in type 2 diabetic patients with severe periodontitis. This trial was registered with the University Hospital Medical Information Network (no. UMIN000006693). (J Diabetes Invest, doi: 10.1111/j.2040-1124.2012.00209.x, 2012).
Department of Periodontology.
Sayaka
S
Katagiri
Division of Periodontology and Endodontology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Sapporo, Japan.
Toshiyuki
T
Nagasawa
Department of Periodontology.
Hiroaki
H
Kobayashi
Department of Periodontology.
Hideyuki
H
Takamatsu
Department of Periodontology ; Global Center of Excellence Program, International Research Center for Molecular Science in Tooth and Bone Diseases.
Pariksha
P
Bharti
Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School ; Tokyo Medical and Dental University Medical Hospital.
Hajime
H
Izumiyama
Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School.
Isao
I
Uchimura
Department of Dentistry and Oral Surgery.
Tadashi
T
Tagami
Department of Periodontology ; Global Center of Excellence Program, International Research Center for Molecular Science in Tooth and Bone Diseases.
Takafumi
T
Suzuki
Department of Periodontology ; Global Center of Excellence Program, International Research Center for Molecular Science in Tooth and Bone Diseases.
Hiromi
H
Nanbara
Department of Periodontology.
Youichi
Y
Taniguchi
Department of Periodontology.
Sae
S
Hayakumo
Department of Periodontology.
Tatsuro
T
Koyanagi
Department of Periodontology.
Akiko
A
Himeno-Ando
Department of Diabetes and Metabolic Medicine and Diabetes Research Center, National Center for Global Health and Medicine, Tokyo.
Maki
M
Goto
Department of Diabetes and Metabolic Medicine and Diabetes Research Center, National Center for Global Health and Medicine, Tokyo.
Hiroshi
H
Kajio
Department of Diabetes and Metabolic Medicine and Diabetes Research Center, National Center for Global Health and Medicine, Tokyo.
Yoshihiko
Y
Takahashi
Department of Periodontology ; Global Center of Excellence Program, International Research Center for Molecular Science in Tooth and Bone Diseases.
Yuichi
Y
Izumi
Department of Diabetes and Metabolic Medicine and Diabetes Research Center, National Center for Global Health and Medicine, Tokyo.
Mitsuhiko
M
Noda
Glycated hemoglobin; Periodontal disease; Type 2 diabetes mellitus