Abstract
BackgroundThere is a burglar association between diabetes and periodontitis. Many studies has shown that periodontitis treatment can help improving glycemic control in diabetes patients but little evidence of non-surgical treatment benefit is available in sub Saharan african diabetes patients. We aimed to assess the effects of non-surgical periodontal treatment (NSPT) of chronic periodontitis on glycaemic control in poorly controlled type 2 diabetes patients (T2D) in a sub-Saharan Africa urban setting.MethodsA total of 34 poorly controlled T2D patients with chronic periodontitis aged 51.4 ± 8.8 years (mean ± SD), with known duration of diabetes of 55.5 ± 42.6 months, and HbA1c of 9.3 ± 1.3% were randomly assigned to two groups. The treatment group (Group 1, n = 17) received immediate ultrasonic scaling, scaling and root planning along with subgingival 10% povidone iodine irrigation, whereas the control group (Group 2, n = 17) was assigned to receive delayed periodontal treatment 3 months later. Pharmacological treatment was unchanged and all participants received the same standardized education session on diabetes management and dental hygiene. The primary outcome was the 3-month change in HbA1c from baseline. Plaque index (PI), gingival bleeding index (GBI), pocket depth (PD), clinical attachment loss (CAL) were also assessed prior to, at 6 and 12 weeks after enrolment.ResultsTwo subjects in each group were excluded from the study. Data were analyzed on thirty patients (15 per group). Non-surgical periodontal treatment with education for better dental hygiene (group 1) significantly improved all periodontal parameters whereas education only (group 2) improved only the plaque index among all periodontal parameters. Immediate non-surgical periodontal treatment induced a reduction of HbA1c levels by 3.0 ± 2.4 points from 9.7 ± 1.6% at baseline to 6.7 ± 2.0% 3 months after NSPT, (p ˂ 0.001) but the change was not significant in group 2, from mean 8.9 ± 0.9% at baseline vs 8.1 ± 2.6% after 3 months (p = 0.24).ConclusionNon-surgical periodontal treatment markedly improved glycaemic control with an attributable reduction of 2.2 points of HbA1c in poorly controlled T2D patients in a sub Saharan setting.Trial registrationClinicalTrials.gov Identifier: NCT02745015 Date of registration: July 17, 2016 ‘Retrospectively registered’.
Highlights
There is a burglar association between diabetes and periodontitis
Despite growing evidence on the benefit of periodontal treatment on glycaemic control in people living with diabetes [19,20,21,22,23,24,25], randomized controlled trial-derived evidence is lacking from Africa, the continent with the largest burden of infectious diseases and uncontrolled diabetes
After a twelve weeks follow-up of non-surgical treatment of chronic periodontitis by full-mouth ultrasonic scaling and root planning associated with sub gingival irrigation with 10% povidone iodine solution, we obtained a significant improvement of glycaemic control translated by a reduction of Glycated haemoglobin (HbA1c) levels to 30.9% of the baseline
Summary
There is a burglar association between diabetes and periodontitis. Many studies has shown that periodontitis treatment can help improving glycemic control in diabetes patients but little evidence of non-surgical treatment benefit is available in sub Saharan african diabetes patients. We aimed to assess the effects of non-surgical periodontal treatment (NSPT) of chronic periodontitis on glycaemic control in poorly controlled type 2 diabetes patients (T2D) in a sub-Saharan Africa urban setting. African and sub-Saharan Africa is faced with a significant and increasing burden of type 2 diabetes (T2D) with high prevalence in urban population, in addition of having the largest proportion of undiagnosed patients in the world. This makes it one of the most vulnerable regions for this condition worldwide and in coming decades [1,2,3]. We carried out this study to assess the effects of non-surgical periodontal treatment on glycated haemoglobin in a sub-Saharan Africa type 2 diabetes populations
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