Effect Of Non-Surgical Periodontal Therapy On Glycemic Control And The Level Of Serum IL-6 In Type 2 Diabetic Patients With Chronic Periodontitis

The aim of the present intervention trial was to evaluate the effect of non-surgical periodontal therapy on periodontal clinical parameters, glycemic control and the level of serum IL-6 in type 2 diabetic patients with chronic periodontitis thereby investigating the possible impact mechanism.Materials and Methods1. Study population:The present study included 55 type 2 diabetic patients with chronic periodontitis (DMCP) and 55 systemically healthy patients with chronic periodontitis(CP) with age from 35 to 71 years old.They were well matched in terms of age and sex.All of the patients were randomly recruited from the clinic of periodontics in the stomatology hospital and the clinic of endocrinology in the first hospital affiliated to the China Medical University, between March 2008 and December 2009. All patients were informed of the principle of the therapy to be applied, and written informed consent was obtained.2. Methods:Periodontal clinical parameters including periodontal probing depth(PD), clinical attachment loss(CAL), bleeding index(BI) and plaque index(PLI) were assessed at baseline and the 6th week and 3rd month following the periodontal therapy. At the same time, venous blood samples were taken from each patient in a resting state during the morning following an overnight fasting between 8:00 am and 10:00 am before the periodontal examination.They were analysed immediately for fasting plasma glucose (FPG), glycated hemoglobin (HbAlc), total cholesterol (TC) and triglyceride (TG). The concentration of serum IL-6 was detected by the method of enzyme-linked immunosorbnent assay(ELISA). Both groups received non-surgical periodontal therapy including oral hygiene instruction, subgingival scaling and root planing for 2 to 4 times within 2 weeks.3. Statistical analysesStatistical analyses were performed using SPSS13.0. Student's t-test or t'-test, paired t-test, Wilcoxon rank sum test, Chi-square test and Bivariate correlations were used in the study. P＜0.05 was considered to be statistically significant.Results1. At baseline the mean of BI, FPG, HbAlc, serum IL-6, TG and TC of DMCP group were significantly higher than the values of CP group(P＜0.05).2. All periodontal clinical parameters of both groups such as PD, CAL, BI, PLI apparently reduced after treatment(P＜0.05).Compared with 6 weeks after treatment, only PLI of DMCP group did not reduce significantly at 3 months after treatment.3. Only the level of HbAlc of the DMCP group apparently improved at 3months after treatment when it was compared with the level at baseline(P＜0.05).4. The levels of serum IL-6 of DMCP group and CP group both significantly decreased at 6 weeks and 3months after treatment when they were compared with the level at baseline(P＜0.05).While only the level of serum IL-6 of CP group reduced significantly at 3 months following the treatment when compared with the level at 6 weeks after treatment(P＜0.05).5. At baseline only the mean FPG and mean HbAlc of group A2(the poorly controlled diabetes, HbAlc＞7.00%) were significantly higher than the values of group Al(the well-controlled diabetes)(P＜0.05). PD and PLI of group A2 and PLI of group Al did not reduce significantly at 3 months following the treatment when compared with the valus at 6 weeks after treatment(P＞0.05). The levels of serum IL-6 of both groups significantly decreased at 3 months after treatment compared with the levels at baseline(P＜0.05).While only the HbAlc of group A2 reduced significantly at 3 months after treatment when compared with the value at baseline or at 6 weeks after treatment.6. Only the changes of CAL and HbAlc of DMCP group between baseline and 3 months reached significance when compared with the values of CP group (P＜0.05).7. the changes of HbAlc((?)HbAlc) and the HbAlc at baseline were positive correlation(P＜0.05).Conclusions1. The level of serum IL-6 of type 2 diabetic patients with chronic periodontitis was significantly higher than the level of systemically healthy patients with chronic periodontitis, which suggested that inflammatory factors played an important role in the development of the two diseases.2. Non-surgical periodontal therapy can improve the periodontal health and the level of serum IL-6, thereby improving their glucose metabolism, local and systemic inflammatory status.3. Diabetic patients with different levels of metabolic control may have different response to the treatement. Non-surgical periodontal therapy may help the poorly controlled diabetic patients improve their glucose metabolism, while did not have significant effect on the well-controlled diabetic patients.