ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Periodontal Therapy Does Not Improve A1c Levels in Diabetic Patients with Periodontal Disease
Clinical Question In patients with periodontal disease and Type II Diabetes, what is the effect of periodontal therapy on HbA1c levels, as compared to the patients’ HbA1c levels prior to periodontal therapy?
Clinical Bottom Line Periodontal therapy does not have an impact on A1c levels in diabetic patients with periodontal disease. A large-scale, well-controlled randomized controlled trial supports this. Their findings do not support the use of non-surgical periodontal therapy in diabetic patients for the purpose of lowering HbA1c levels.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24346989Engebretson/2013257 Type 2 diabetics with chronic periodontal diseaseRandomized Controlled Trial
Key resultsThere was not a significant difference for change in HbA1c levels between the group receiving periodontal treatment and the control group (−0.05%[95%CI, −0.23% to 0.12%]); P = .55).
Evidence Search (("periodontal diseases"[MeSH Terms] OR ("periodontal"[All Fields] AND "diseases"[All Fields]) OR "periodontal diseases"[All Fields] OR ("periodontal"[All Fields] AND "disease"[All Fields]) OR "periodontal disease"[All Fields]) AND ("diabetes mellitus"[MeSH Terms] OR ("diabetes"[All Fields] AND "mellitus"[All Fields]) OR "diabetes mellitus"[All Fields] OR "diabetes"[All Fields] OR "diabetes insipidus"[MeSH Terms] OR ("diabetes"[All Fields] AND "insipidus"[All Fields]) OR "diabetes insipidus"[All Fields])) AND Randomized Controlled Trial[ptyp]
Comments on
The Evidence
Validity: This study was a large scale (n=257), multicenter, and well-controlled randomized controlled trial. Additionally, the risk for bias is low. Perspective: This is the largest study on this topic to date. It also takes into account medical management of the participants' diabetes. These results differ from a number of small studies and systematic reviews showing a positive relationship. This difference is likely due to increased bias and confounding in the small sized studies combined with a lack of evaluation of diabetes management. CAT 619 addresses a similar issue. The above study was completed after the publication of CAT 619. This study was completed on a much larger patient base than those used in previous studies. Additionally, this study took into account changes in medical management of patients diabetes. It provides clear evidence that periodontal therapy does not impact diabetic patients HbA1c levels.
Applicability This study is applicable to dentists who treat diabetic patients. While the periodontal benefits of periodontal therapy are indisputable, claims regarding its effects on HbA1c are not supported by the results of this study.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Diabetes, Periodontal Surgery, HbA1c
ID# 2832
Date of submission: 03/27/2015spacer
E-mail felknerj@livemail.uthscsa.edu
Author Justin Felkner
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Thomas Oates, DMD, PhD
Faculty mentor/Co-author e-mail Oates@uthscsa.edu
Basic Science Rationale
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Comments on the CAT
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