Improvement of glycemic control after periodontal treatment by resolving gingival inflammation in type 2 diabetic patients with periodontal disease

Sayaka Katagiri; Toshiyuki Nagasawa; Hiroaki Kobayashi; Hideyuki Takamatsu; Pariksha Bharti; Hajime Izumiyama; Isao Uchimura; Tadashi Tagami; Takafumi Suzuki; Hiromi Nanbara; Youichi Taniguchi; Sae Hayakumo; Tatsuro Koyanagi; Akiko Himeno-Ando; Maki Goto; Hiroshi Kajio; Yoshihiko Takahashi; Yuichi Izumi; Mitsuhiko Noda

doi:10.1111/j.2040-1124.2012.00209.x

Improvement of glycemic control after periodontal treatment by resolving gingival inflammation in type 2 diabetic patients with periodontal disease

J Diabetes Investig. 2012 Aug 20;3(4):402-9. doi: 10.1111/j.2040-1124.2012.00209.x.

Authors

Sayaka Katagiri¹, Toshiyuki Nagasawa², Hiroaki Kobayashi¹, Hideyuki Takamatsu¹, Pariksha Bharti³, Hajime Izumiyama⁴, Isao Uchimura⁵, Tadashi Tagami⁶, Takafumi Suzuki³, Hiromi Nanbara³, Youichi Taniguchi¹, Sae Hayakumo¹, Tatsuro Koyanagi¹, Akiko Himeno-Ando¹, Maki Goto⁷, Hiroshi Kajio⁷, Yoshihiko Takahashi⁷, Yuichi Izumi³, Mitsuhiko Noda⁷

Affiliations

¹ Department of Periodontology.
² Division of Periodontology and Endodontology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Sapporo, Japan.
³ Department of Periodontology ; Global Center of Excellence Program, International Research Center for Molecular Science in Tooth and Bone Diseases.
⁴ Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School ; Tokyo Medical and Dental University Medical Hospital.
⁵ Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School.
⁶ Department of Dentistry and Oral Surgery.
⁷ Department of Diabetes and Metabolic Medicine and Diabetes Research Center, National Center for Global Health and Medicine, Tokyo.

Abstract

Aims/Introduction: Chronic inflammation aggravates glycemic control in patients with type 2 diabetes mellitus. An increase or decrease in the release and activities of various inflammatory mediators, such as tumor necrosis factor (TNF)-α, interleukin (IL)-6, and C-reactive protein (CRP), are presumed to be responsible for inducing insulin resistance. The purpose of the present study was to examine the effects of non-surgical periodontal treatment incorporating topical antibiotics on glycemic control and serum inflammatory mediators in patients with type 2 diabetes mellitus with periodontitis.

Materials and methods: Periodontal inflammation and periodontal tissue destruction were evaluated by bleeding on probing (BOP) and the probing pocket depth (PPD), respectively. A total of 41 patients with type 2 diabetes and periodontitis received periodontal treatment with the topical application of antibiotics four times within a 2-month period. A periodontal examination, including PPD and BOP, and venous blood sampling were carried out at baseline and at 2 and 6 months after periodontal treatment. Glycated hemoglobin (HbA1c), and serum levels of high-sensitivity (hs)-CRP, TNF-α and IL-6 were analyzed.

Results: A generalized linear model showed significant associations between the change in the HbA1c values at 6 months after periodontal treatment, and the change in the BOP, baseline TNF-α levels and the baseline mean PPD.

Conclusions: As BOP is a marker of total gingival inflammation, these results suggest that non-surgical periodontal therapy with topical antibiotics in patients with mild periodontitis might improve glycemic control by resolving periodontal inflammation. Such treatments might be insufficient for the amelioration of insulin resistance in type 2 diabetic patients with severe periodontitis. This trial was registered with the University Hospital Medical Information Network (no. UMIN000006693). (J Diabetes Invest, doi: 10.1111/j.2040-1124.2012.00209.x, 2012).

Keywords: Glycated hemoglobin; Periodontal disease; Type 2 diabetes mellitus.