The effects of non-surgical periodontal treatment on glycemic control, oxidative stress balance and quality of life in patients with type 2 diabetes: A randomized clinical trial.

Hirofumi Mizuno,Takayuki Maruyama,Jun Wada,Toshiki Yoneda,Manabu Morita,Kota Kataoka,Yoshio Sugiura,Takaaki Tomofuji,Daiki Fukuhara,Daisuke Ekuni

doi:10.1371/journal.pone.0188171

Abstract

AimThe purpose of this study was to investigate the effects of non-surgical periodontal treatment on hemoglobinA1c (HbA1c) levels, oxidative stress balance and quality of life (QOL) in patients with type 2 diabetes mellitus (T2DM) compared to no periodontal treatment (simple oral hygiene instructions only).MethodsThe design was a 6-month, single-masked, single center, randomized clinical trial. Patients had both T2DM and chronic periodontitis. Forty participants were enrolled between April 2014 and March 2016 at the Nephrology, Diabetology and Endocrinology Department of Okayama University Hospital. The periodontal treatment group (n = 20) received non-surgical periodontal therapy, including scaling and root planing plus oral hygiene instructions, and consecutive supportive periodontal therapy at 3 and 6 months. The control group (n = 17) received only oral hygiene instructions without treatment during the experimental period. The primary study outcome was the change in HbA1c levels from baseline to 3 months. Secondary outcomes included changes in oxidative stress balance (Oxidative-INDEX), the Diabetes Therapy-Related QOL and clinical periodontal parameters from baseline to 3 months and baseline to 6 months.ResultsChanges in HbA1c in the periodontal treatment group were not significantly different with those in the control group at 3 and 6 months. Systemic oxidative stress balance and QOL significantly improved in the periodontal treatment group compared to the control group at 3 months. In the subgroup analysis (moderately poor control of diabetes), the decrease in HbA1c levels in the periodontal treatment group was greater than that in the control group at 3 months but not significant.ConclusionsIn T2DM patients, non-surgical periodontal treatment improved systemic oxidative stress balance and QOL, but did not decrease HbA1c levels at 3 months follow-up.Trial registrationCurrent Controlled Trials UMIN-ICDR UMIN 000013278 (Registered April 1, 2014).

Highlights

Type 2 diabetes mellitus (T2DM) is a common chronic disease and can cause various health issues
Systemic oxidative stress balance and quality of life (QOL) significantly improved in the periodontal treatment group compared to the control group at 3 months
We previously showed that non-surgical periodontal treatment reduced systemic oxidative stress in healthy patients [26]

Summary

Introduction

Type 2 diabetes mellitus (T2DM) is a common chronic disease and can cause various health issues. Treatment goals include the prevention of complications as well as glycemic control [1]. Periodontitis and diabetes are chronic diseases with an established bidirectional relationship. Periodontitis is recognized as the sixth complication of diabetes [3] and is a major cause of tooth loss in adults [4]. Recent reviews suggest that periodontitis adversely affects diabetes outcomes. Evidence for treatment benefits remains controversial due to the variety of the sample population, methods and control of T2DM [2, 6,7,8,9,10,11,12,13,14]

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