ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Effect Of Control Of Periodontal Disease On Uncontrolled Type II Diabetics
Clinical Question In a patient with uncontrolled Type II diabetes and corresponding oral disease, will therapeutic management of their periodontitis improve their glycemic control?
Clinical Bottom Line There is no definitive evidence supporting the idea that improving periodontal health in a Type II diabetic directly improves that patient’s glycemic control; several studies support the idea while others (not included in this CAT) show no effect. (See Comments on the CAT below)
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) 16304446Janket/2005Diabetic Patients (Type 1 and 2 included)Meta-Analysis
Key resultsAverage HbA1c levels for all patients decreased by 0.38% while specifically type 2 diabetic patients decreased by 0.66%; change in HbA1c levels was not statistically significant. Limitation of the study due to the inclusion of Type I diabetics who have more tightly controlled insulin levels; whereas if only Type II diabetics were included study might have shown more accurate effects of periodontal treatment.
#2) 15766369Kiran/2005Type 2 Diabetes Mellitus patients with HbA1c levels between 6-8%RCT
Key resultsStatistically significant improvement in patient group’s, PI, GI, PPD, CAL, and BOP after periodontal treatment. HbA1c levels for patient group decreased significantly corresponding to periodontal treatment; control group showed slight, but insignificant increase in levels.
Evidence Search Search "Diabetes Mellitus, Type 2"[Mesh] AND "Periodontal Diseases"[Mesh] Limits: Meta-Analysis, Randomized Controlled Trial, Search "Diabetes Mellitus, Type 2"[Mesh] AND "Periodontal Diseases"[Mesh]
Comments on
The Evidence
The Janket paper was a meta-analysis that included a good sample of subjects however, because the search included the years 1980 to the 2005, some of the material could be outdated. Also, because both insulin dependent and non insulin dependent diabetic patients were included, the results did not directly apply to the PICO question. In the Kiran study, multiple clinical and laboratory tests were measured, allowing for results in a variety of parameters. However, this study used a very small number of subjects, completion rate was limited and it was a relatively short term study.
Applicability Both studies are applicable to diabetic patients that could be seen in a dental office and although the first study has a much stronger evidence base, it is not totally specific to the PICO question. The second study is more applicable to the PICO question but it is not as reliable to due the limited sample size. It also was a local study making it difficult to generalize the results to a broader population.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Type 2 diabetes, periodontal disease, control of diabetic condition, HbA1c
ID# 619
Date of submission: 04/12/2010spacer Revised: 10/25/2011
E-mail furini@livemail.uthscsa.edu
Author Allison Furini
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Michaell A. Huber, DDS
Faculty mentor/Co-author e-mail HuberM@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Katherine Maldonado (San Antonio, TX) on 07/20/2011
The strongest evidence I found on PubMed was a Meta Analysis from the Cochrane Database Systematic Review, PubMed: 20464734. It was found that there is a level of improvement In people with diabetes after treatment of periodontal disease. The answer to the clinical question is still valid.
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