Weak Evidence Suggests Scaling and Root Planing May Help People With Diabetes Improve Glycemic Control

Abstract

Systematic review conclusion. Periodontal treatment may improve glycemic control in adults with poorly controlled diabetes, although the research basis for this statement is not robust.Critical summary assessment. This systematic review followed a clear protocol for locating and assessing all pertinent studies. The studies were of variable quality, with only one randomized controlled trial considered to be of high quality. The review does not provide a confident basis for determining whether scaling and root planing can improve glycemic control in people with diabetes.Evidence quality rating. Limited. Systematic review conclusion. Periodontal treatment may improve glycemic control in adults with poorly controlled diabetes, although the research basis for this statement is not robust. Critical summary assessment. This systematic review followed a clear protocol for locating and assessing all pertinent studies. The studies were of variable quality, with only one randomized controlled trial considered to be of high quality. The review does not provide a confident basis for determining whether scaling and root planing can improve glycemic control in people with diabetes. Evidence quality rating. Limited. Do adults with diabetes who receive periodontal therapy experience improved glycemic control compared with similar patients who do not receive periodontal treatment? The authors of this systematic review conducted a search of seven databases with no language restrictions and publication dates from January 1976 to December 2007; they also included unpublished research. They followed a clear protocol, with two independent reviewers identifying studies and extracting data. The authors considered studies for inclusion if they were original interventional investigations and involved human subjects for whom glycosylated hemoglobin (HbA1c) levels were reported. The authors reported the results of the systematic review and meta-analysis. They followed the Quality of Reporting of Meta-analyses (QUOROM) recommendations.1Moher D Cook DJ Eastwood S Olkin I Rennie D Stroup DF Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement.Lancet. 1999; 354: 1896-1900Abstract Full Text Full Text PDF PubMed Scopus (3943) Google Scholar The authors of the systematic review included 25 studies with a total of 976 participants. Of these 25 studies, only nine were randomized controlled trials. These nine trials had sample sizes ranging from 22 to 165 participants, and investigators used varied treatment modalities. Overall, the meta-analysis demonstrated a moderate, statistically significant result favoring the therapeutic group (standardized mean difference in HbA1c, 0.46; 95 percent confidence interval [CI], 0.11–0.82; P = .01). This result may be interpreted as a small but statistically significant improvement in glycemic control (0.79 percent; 95 percent CI, 0.19–1.40). The best information available suggests that scaling and root planing can improve glycemic control. However, caution is advised, because despite the general trend of these results, the studies have shortcomings that may influence the findings.