The effect of non-surgical periodontal therapy on glycemic control in Indian diabetics with periodontal disease – A systematic review and meta-analysis
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Background: Periodontitis is a chronic inflammatory condition that contributes to systemic complications. It is associated with an increased risk of poor glycemic control and other diabetes-related complications. Purpose: This review aimed to evaluate the effect of nonsurgical periodontal therapy (NSPT) on the metabolic level of diabetes (HbA1c) in diabetic patients with generalized chronic periodontitis (GCP) in the Indian population. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria were followed for conducting the review. PubMed-MEDLINE, Cochrane Library, Scopus, and Google Scholar were searched from inception until January 30, 2025. The Cochrane risk of bias (ROB)-2 tool for randomized controlled trials (RCT) was used to assess quality. A p value of less than 0.05 was considered statistically significant, and the standardized mean difference (SMD) was employed as a summary statistic measure using a random effect model. Results: Eleven studies fulfilled the eligibility criteria and were included in the qualitative synthesis, of which only six studies were suitable for meta-analysis. The pooled estimate through the SMD signifies that periodontal therapy, or NSPT, had a significant reduction in the clinical parameters assessed (p < 0.05). Publication bias through the funnel plot showed symmetric distribution with the absence of systematic heterogeneity. Conclusion: This study highlights that NSPT as a standalone therapy significantly reduces metabolic markers, specifically HbA1c, in diabetic patients. Additionally, notable improvements in clinical parameters were observed following NSPT. Therefore, periodontal therapy should be considered for patients with elevated metabolic markers (HbA1c), as it may help to reduce both the inflammatory burden and HbA1c levels associated with diabetes.
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Ramadan DE, Hariyani N, Indrawati R, Ridwan RD, Diyatri I. Cytokines and chemokines in periodontitis. Eur J Dent. 2020; 14(3): 483–95. doi: https://doi.org/10.1055/s-0040-1712718
Berniyanti T, Wening GRS, Palupi R, Setyowati D, Putri CR. Low levels of tumor necrosis factor-α will prevent periodontitis exacerbation in type 2 diabetes mellitus. Eur J Dent. 2022; 16(02): 443–8. doi: https://doi.org/10.1055/s-0041-1739442
Mehta V, Fiorillo L, Langaliya A, Obulareddy VT, Cicciu M. The Effect of Xenograft and Platelet-Rich Plasma in the Surgical Management of Intrabony Defects in Periodontitis Patients: A Systematic Review. J Craniofac Surg. 2023; 34(7): 2222–7. doi: https://doi.org/10.1097/SCS.0000000000009612
Dağ A, Fırat E, Arıkan Ş, Kadiroğlu A, Kaplan A. The effect of periodontal therapy on serum TNF‐α and HbA1c levels in type 2 diabetic patients. Aust Dent J. 2009; 54(1): 17–22. doi: https://doi.org/10.1111/j.1834-7819.2008.01083.x
Mulawarmanti D, Widyastuti W. Effect of oxygen hyperbaric therapy on malondialdehyde levels in saliva of periodontitis patients with type 2 diabetes mellitus. Dent J (Majalah Kedokt Gigi). 2008; 41(4): 151. doi: https://doi.org/10.20473/j.djmkg.v41.i4.p151-154
Bagwe S, Gopalakrishnan D, Mehta V, Mathur A, Kapare K, Deshpande A. GCF and serum levels of omentin in periodontal health and disease of diabetic and non-diabetic individuals: A comparative study. Indian J Dent Res. 2020; 31(4): 520. doi: https://doi.org/10.4103/ijdr.IJDR_796_18
Mehta V, Kaçani G, Moaleem MM Al, Almohammadi AA, Alwafi MM, Mulla AK, Alharbi SO, Aljayyar AW, Qeli E, Toti Ç, Meto A, Fiorillo L. Hyaluronic Acid: A New Approach for the Treatment of Gingival Recession-A Systematic Review. Int J Environ Res Public Health. 2022; 19(21): 14330. doi: https://doi.org/10.3390/ijerph192114330
Singh S, Kumar V, Kumar S, Subbappa A. The effect of periodontal therapy on the improvement of glycemic control in patients with type 2 diabetes mellitus: A randomized controlled clinical trial. Int J Diabetes Dev Ctries. 2008; 28(2): 38. doi: https://doi.org/10.4103/0973-3930.43097
Telgi RL, Tandon V, Tangade PS, Tirth A, Kumar S, Yadav V. Efficacy of nonsurgical periodontal therapy on glycaemic control in type II diabetic patients: a randomized controlled clinical trial. J Periodontal Implant Sci. 2013; 43(4): 177. doi: https://doi.org/10.5051/jpis.2013.43.4.177
Kanduluru A, Naganandini S. Effect of nonsurgical periodontal treatment on clinical response and glycemic control in type 2 diabetic patients with periodontitis: Controlled clinical trial. J Indian Assoc Public Heal Dent. 2014; 12(4): 261–7. doi: https://doi.org/10.4103/2319-5932.147643
Kıran M, Arpak N, Ünsal E, Erdoğan MF. The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus. J Clin Periodontol. 2005; 32(3): 266–72. doi: https://doi.org/10.1111/j.1600-051X.2005.00658.x
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009; 6(7): e1000097. doi: https://doi.org/10.1371/journal.pmed.1000097
DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemp Clin Trials. 2015; 45: 139–45. doi: https://doi.org/10.1016/j.cct.2015.09.002
Corbett MS, Higgins JPT, Woolacott NF. Assessing baseline imbalance in randomised trials: implications for the Cochrane risk of bias tool. Res Synth Methods. 2014; 5(1): 79–85. doi: https://doi.org/10.1002/jrsm.1090
Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Stat Med. 2002; 21(11): 1539–58. doi: https://doi.org/10.1002/sim.1186
Sterne JAC, Becker BJ, Egger M. The funnel plot. In: Rothstein HR, Sutton AJ, Borenstein M, editors. Publication bias in meta‐analysis: prevention, assessment and adjustments. Wiley; 2005. p. 73–98. doi: https://doi.org/10.1002/0470870168.ch5
Kumar M, Bandyopadhyay P, Mishra L, Das S, Kundu PK, Mistry S. Effect of periodontal therapy on glycemic control and circulating TNF-α in type 2 diabetic patients. Int J Diabetes Dev Ctries. 2015; 35(2): 96–102. doi: https://doi.org/10.1007/s13410-014-0236-5
K. Kaur P, C. Narula S, Rajput R, K. Sharma R, Tewari S. Periodontal and glycemic effects of nonsurgical periodontal therapy in patients with type 2 diabetes stratified by baseline HbA1c. J Oral Sci. 2015; 57(3): 201–11. doi: https://doi.org/10.2334/josnusd.57.201
Mammen J, Vadakkekuttical RJ, George JM, Kaziyarakath JA, Radhakrishnan C. Effect of non‐surgical periodontal therapy on insulin resistance in patients with type II diabetes mellitus and chronic periodontitis, as assessed by C‐peptide and the Homeostasis Assessment Index. J Investig Clin Dent. 2017; 8(3). doi: https://doi.org/10.1111/jicd.12221
Gurrala S, Mutthineni R, Chintala S, Pabolu C. Reduction of HbA1c levels following nonsurgical treatment of periodontal disease in Type 2 diabetics. J Dr NTR Univ Heal Sci. 2013; 2(2): 109. doi: https://doi.org/10.4103/2277-8632.112335
Agarwal M, Chaubey K, Madan E, Agarwal S. Effect of periodontal therapy on type 2 diabetes mellitus patients with chronic periodontitis with the evaluation of HbA1c. J Int Clin Dent Res Organ. 2016; 8(1): 34. doi: https://doi.org/10.4103/2231-0754.176248
Aryal S, Pradhan A, Shrestha SM. Does Improved Periodontal Health affect Metabolic and Inflammatory Markers in Patients with Diabetes Mellitus? A Comparative Study. J Nepal Soc Periodontol Oral Implantol. 2017; 1(1): 2–6. doi: https://doi.org/10.3126/jnspoi.v1i1.23519
Sundar C, Ramalingam S, Mohan V, Pradeepa R, Ramakrishnan M. Periodontal therapy as an adjunctive modality for HbA1c reduction in type-2 diabetic patients. J Educ Health Promot. 2018; 7(1): 152. doi: https://doi.org/10.4103/jehp.jehp_66_18
Tummakomma P, Durvasula S, Soorneedi N, Mohammed K, Abidullah M, Tabassum SN. The Effect of Phase I Therapy on the Clinical Parameters, VSC Levels, and RBS Levels in Chronic Periodontitis Patients With Diagnosed Diabetes. J Pharm Bioallied Sci. 2020; 12(Suppl 1): S78–85. doi: https://doi.org/10.4103/jpbs.JPBS_31_20
Corbella S, Francetti L, Taschieri S, De Siena F, Fabbro M Del. Effect of periodontal treatment on glycemic control of patients with diabetes: A systematic review and meta‐analysis. J Diabetes Investig. 2013; 4(5): 502–9. doi: https://doi.org/10.1111/jdi.12088
Baeza M, Morales A, Cisterna C, Cavalla F, Jara G, Isamitt Y, Pino P, Gamonal J. Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis. J Appl Oral Sci. 2020; 28: e20190248. doi: https://doi.org/10.1590/1678-7757-2019-0248
Raman RPC, Taiyeb-Ali TB, Chan SP, Chinna K, Vaithilingam RD. Effect of nonsurgical periodontal therapy verses oral hygiene instructions on Type 2 diabetes subjects with chronic periodontitis: A randomised clinical trial. BMC Oral Health. 2014; 14(1): 1–10. doi: https://doi.org/10.1186/1472-6831-14-79
Madianos PN, Koromantzos PA. An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes. J Clin Periodontol. 2018; 45(2): 188–95. doi: https://doi.org/10.1111/jcpe.12836
Moeintaghavi A, Arab H, Bozorgnia Y, Kianoush K, Alizadeh M. Non‐surgical periodontal therapy affects metabolic control in diabetics: a randomized controlled clinical trial. Aust Dent J. 2012; 57(1): 31–7. doi: https://doi.org/10.1111/j.1834-7819.2011.01652.x
Jain A, Gupta J, Bansal D, Sood S, Gupta S, Jain A. Effect of scaling and root planing as monotherapy on glycemic control in patients of Type 2 diabetes with chronic periodontitis: A systematic review and meta-analysis. J Indian Soc Periodontol. 2019; 23(4): 303. doi: https://doi.org/10.4103/jisp.jisp_417_18
Genco RJ, Grossi SG, Ho A, Nishimura F, Murayama Y. A Proposed Model Linking Inflammation to Obesity, Diabetes, and Periodontal Infections. J Periodontol. 2005; 76(11S): 2075–84. doi: https://doi.org/10.1902/jop.2005.76.11-S.2075
Saito T, Shimazaki Y. Metabolic disorders related to obesity and periodontal disease. Periodontol 2000. 2007; 43(1): 254–66. doi: https://doi.org/10.1111/j.1600-0757.2006.00186.x
Mathers CD, Loncar D. Projections of Global Mortality and Burden of Disease from 2002 to 2030. Samet J, editor. PLoS Med. 2006; 3(11): e442. doi: https://doi.org/10.1371/journal.pmed.0030442
Gamonal J, Mendoza C, Espinoza I, Muñoz A, Urzúa I, Aranda W, Carvajal P, Arteaga O. Clinical Attachment Loss in Chilean Adult Population: First Chilean National Dental Examination Survey. J Periodontol. 2010; 81(10): 1403–10. doi: https://doi.org/10.1902/jop.2010.100148
Duque A. Prevalencia de periodontitis crónica en Iberoamérica. Rev Clínica Periodoncia, Implantol y Rehabil Oral. 2016; 9(2): 208–15. doi: https://doi.org/10.1016/j.piro.2016.07.005
Chávarry NGM, Vettore MV, Sansone C, Sheiham A. The relationship between diabetes mellitus and destructive periodontal disease: a meta-analysis. Oral Health Prev Dent. 2009; 7(2): 107–27. pubmed: https://pubmed.ncbi.nlm.nih.gov/19583037/
Bascones-Martínez A, Muñoz-Corcuera M, Bascones-Ilundain J. Diabetes y periodontitis: una relación bidireccional. Med Clin (Barc). 2015; 145(1): 31–5. doi: https://doi.org/10.1016/j.medcli.2014.07.019
Torrungruang K, Katudat D, Mahanonda R, Sritara P, Udomsak A. Periodontitis is associated with elevated serum levels of cardiac biomarkers—Soluble ST2 and C‐reactive protein. J Clin Periodontol. 2019; 46(8): 809–18. doi: https://doi.org/10.1111/jcpe.13149
Nathania I, Harsas NA, Natalina, Tadjoedin FM. Relationship between the levels of awareness and knowledge of periodontitis in diabetic patients at a Dental Hospital during the COVID-19 pandemic. Dent J. 2023; 56(4): 243–50. doi: https://doi.org/10.20473/j.djmkg.v56.i4.p243-250
Alghazaly F, Hariyani N, Setyowati D, Alghazali K, Aljunaid MA. Impacts of diabetes mellitus oral manifestation on quality of life: a systematic review. J Int Oral Heal. 2024; 16(6): 421–31. doi: https://doi.org/10.4103/jioh.jioh_48_24
Palupi R, Berniyanti T, Akbar R, Bramantoro T, Hariyani N, Ramadhani A, Romadhoni SF. Functional factors on compliance drugs consumption in diabetes melitus patients related to periodontal health. Indian J Public Heal Res Dev. 2019; 10(8): 1049–53. doi: https://doi.org/10.5958/0976-5506.2019.02034.5
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