| Diabetes mellitus is a metabolic disease characterized by abnormal elevation in blood glucose levels. It is a significant cause of mortality and morbidity in both developed and developing countries. Followed with rapid economic growth and changes in lifestyle, the prevalence of diabetes is increasing rapidly and being a public-health burden in China. A Chinese national epidemiological study published in2010has indicated that about92.4million Chinese adults20years of age or older (9.7%of the adult population) have diabetes. About85%to90%of diabetic cases are type2diabetes, which is the most prevalent type of diabetes among middle-aged subjects; it results from insulin rtesistance, impairing insulin function.Periodontitis is the most common chronic oral infection and major cause of tooth loss in adults. Severe periodontal disease, which may result in tooth loss, is found in15-20%of middle-aged (35-44years) adults. Besides of the local destruction, periodontitis has also been considered as the sixth complication of diabetes mellitus. Conversely, periodontitis was shown to be a risk factor for poor glycemic control in diabetic patients. It was considered that local periodontal infection may lead to a systemic burden of inflammatory mediators that exacerbate the metabolic disorder in patients with diabetes. The relationship between periodontitis and diabetes has been largely described in the literature since the1960s. There is emerging evidence to support that there is a two-way relationship between diabetes and periodontitis. Diabetes increases the risk for periodontitis, and periodontal inflammation negatively affects glycaemic control.The objective of this study aims to explore the relationship of periodontitis with diabetes and clarify effects of periodontal treatment on periodontitis control, metabolic level and systemic inflammatory status in patients with type2diabetes.Objectives:To investigate the effect of periodontal non-surgical treatment on periodontal tissue inflammation, glucose metabolic status, lipid metabolic level and serum levels of inflammatory markers in patients with type2diabetes.Methods:The study population consisted of115patients (63males) with type2DM, aged40-75years (mean±SD,59.52±8.88), with A1C levels ranging from7%to10%and having at least16teeth present.From November2008to October2009,134patients with diabetes (68males and66females; aged38to81years) participating in a cross-sectional investigation described previously, were recruited for this longitudinal study. All the patients had a confirmed diagnosis of Type2diabetes mellitus for>1year, with no change in their diabetic treatment plan in the previous2months and with no major diabetic complication, such as coronary heart disease. To be eligible for inclusion, participants had to have a clinical diagnosis of chronic periodontitis according to the American Academy of Periodontology criteria, with a≥1mm mean clinical attachment loss ([AL]; including slight, moderate, and severe periodontitis), with≥16teeth. Exclusion criteria included:1) the presence of a systemic disease other than diabetes that could influence the course of the periodontal disease;2) systemic antibiotic administration within the previous3months;3) pregnancy or lactation; or4) refusal to provide written in-formed consent. Patients were also excluded if they had an active infection other than periodontitis or had received periodontal treatment in the previous12months.Subjects meeting eligibility criteria were randomly assigned into three groups: treatment group1, treat-ment group2, and the control group with a1:1:1allocation. The allocation sequence was masked from the researcher, who was responsible for enrolling and assessing participants named in sequentially numbered envelopes (1to134).Patients in treatment group1received non-surgical periodontal treatment, which consisted of scaling and root planing under local anesthesia at baseline and additional subgingival debridement at the3-month follow-up. Those in treatment group2underwent non-surgical periodontal treatment at the initial visit and only supragingival prophylaxis, with no intervention in deep periodontal pockets at3months. Those in the control group received no treatment measure or formal oral hygiene instructions until the end of the study. Non-surgical periodontal treatment was com-pleted within24hours by an experienced periodontist without the administration of antibiotics or local antimicrobials at baseline, using standard rigid periodontal curets and ultrasonic instrumentation.Patients were then reexamined at1.5,3,6and12months after completion of the initial periodontal therapy. At each visit, clinical periodontal examinations, blood tests, and immunologic studies were performed in all groups, with reinforcement of the oral hygiene instructions for patients in the two treatments groups.Ethics approval was gained from the Medical Ethics Committee of Southern Medical University, Guangzhou, China,(Chinese Clinical Trial Registry Number ChiCTR-TRC-10001062) before implementation of the study. Written informed consent was obtained from all participants at the beginning of the study.Statistical analysisAll the data were analyzed using SPSS13.0statistical software, Bilateral level at P<0.05was selected. With the balance between three groups at baseline, the differences of the test parameters between different visit points before and after non-surgical periodontal treatment were analyzed with repeated measures, when the test of sphericity was not been satisfied, Greenhouse-Gerisser method was used. Missing data were treated with the LOCF (Last observation forward) method.Results1. In this study, the total of134patients were included,19lost,115people entered the last stage of follow-up observations, including37in treatment group1、40in treatment group2and38in control group, and all subjects finished follow-up to12months after treatment.2. The present study showed, mean PD, PLI, BOP and mean AL in group1and group2significantly reduced in comparison with control group. There was no significant difference between group1and group2.3. Non-surgical periodontal therapy could improve metabolic control(HbAlc and FPG) in diabetic patients at6month, but the effect was not significant at12month. At6months, group1and group2had a significant lower hsCRP level in comparison with control group, with no difference in group1and group2.4. Although there was a trend to reduce TG, TC, HDL-C and LDL-C in three groups during the whole study period, but no significant difference were found among the three groups. Fluctuation of TNF-a level in three groups did not show significance after treatment and there was no difference among the three groups.Conclusion1. Non-surgical periodontal treatment effectively improved periodontal condition in type2diabetes patients with chronic periodontitis.2. Non-surgical periodontal therapy could improve metabolic control in diabetic patients at6month, but the effect was not significant at12month.3. It is still unclear whether non-surgical periodontal therapy in type2diabetes with chronic periodontitis significantly improved serum lipid metabolism.4. The present study showed significant decreases in CRP six months after non-surgical periodontal therapy, while TNF-a remained unchanged. |
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