HbA1c changes in patients with diabetes following periodontal therapy

Preliminary evaluation of the impact of periodontal treatment on markers of glycaemic control in dogs with diabetes mellitus: A prospective, clinical case series

BACKGROUND

Periodontal disease (PD) can adversely affect glycaemic control in humans. However, it is unknown if a similar association exists in dogs.

METHODS

Ten client-owned dogs with poorly regulated diabetes mellitus (DM) and PD were prospectively enrolled. A complete blood count, serum biochemistry, urinalysis and measurement of C-reactive protein, interleukin-6 (IL-6), tumour necrosis factor-α, haemoglobin A1c (HbA1c) and fructosamine concentrations were performed before periodontal treatment (PT) and monthly thereafter for 3 months. A periodontal disease severity score (PDSS) was determined during PT. The effects of time post-PT and PDSS on markers of inflammation and glycaemic control were determined by generalised estimating equation analysis.

RESULTS

HbA1c (mean; 95% confidence interval [CI]) decreased 3 months post-PT (32.1 mmol/mol; 21.1-43.1 mmol/mol vs. 44.3 mmol/mol; 36.4-52.0; p = 0.003). PDSS at enrolment was significantly (p = 0.031) positively associated with HbA1c concentration. Due to a significant (p < 0.001) interaction between PDSS and time post-PT in the analysis of fructosamine, dogs with low (1-3) PDSS and high (7-9) PDSS were analysed separately. Fructosamine (mean; 95% CI) significantly decreased 1 month post-PT (570 μmol/L; 457-684 μmol/L vs. 624 μmol/L; 499-748; p = 0.001) in the high PDSS group but not in the low PDSS group. Fructosamine concentration upon enrolment and PDSS were correlated (r = 0.73, p = 0.017). IL-6 concentration significantly decreased 3 months post-PT (9.9 pg/mL; 8.5-11.3 pg/mL vs. 11.2 pg/mL; 9.7-12.7; p = 0.002).

LIMITATIONS

Limitations of the study included the small number of dogs, the lack of a control group and the inability to assess PDSS during follow-ups.

CONCLUSIONS

These findings support a potential detrimental interaction between PD and DM. The apparent beneficial effect of PT on markers of glycaemic control was most conspicuous in dogs with more severe PD.

Improvement of oral health knowledge and behavior of diabetic patients: an interventional study using the social media

BACKGROUND

Diabetic patients are not often aware of relationship between diabetes mellitus (DM) and periodontal diseases, and the researchers recommend further knowledge enhancement of diabetic patients in this regard. This study aimed to enhance oral health knowledge of diabetic adults via an educational intervention.

METHODS

In this interventional study, three private offices of endocrinologists specialized in treatment of DM were selected for the recruitment of participants. In total, 120 diabetic adults (40 from each office) took part in an educational intervention in three groups (patients from each office made up one group): (I) physician-aid, (II) researcher-aid, and (III) social media. In group (I), participants received educational materials (brochure and CD) from their endocrinologist, in group (II) participants received educational materials from researcher. Group (III) joining an educational group in WhatsApp for 3 months. A self-reported standard questionnaire was filled out by the patients before, and after the intervention to assess oral health knowledge. Data were analyzed by SPSS version 21 using independent t-test, Mann-Whitney test, Chi-square test, and ANCOVA.

RESULTS

The mean oral health knowledge score increased in all three groups after the educational interventions (P < 0.001); the highest increase occurred in the social media group. Toothbrushing twice daily or more had the greatest improvement in the physician-aid group compared with the other two groups (P < 0.001). The greatest improvement in dental flossing once daily or more occurred in the social media group (P = 0.01). The mean level of the hemoglobin A1c (HbA1c) decreased in all three groups, but not significantly (P = 0.83).

CONCLUSION

The results showed that educational interventions enhance oral health knowledge, and improve the behavior of diabetic adults. The education via the social media can be an efficient method for knowledge enhancement of diabetic patients.

Prevalence and Associated Factors for Periodontal Disease among Type I and II Diabetes Mellitus Patients: A Cross-Sectional Study

In Saudi Arabia, the prevalence of diabetes mellitus (DM) is high. DM is a risk factor for periodontal disease. The current study aimed to estimate the prevalence and potential associated factors for periodontitis among type I and II DM patients in Abha, Saudi Arabia. A cross-sectional study was conducted among patients with DM who attended the Periodontal Consultant Center at King Khalid University and Aseer Central Hospital, in Abha city, from January 2020 to January 2022. A questionnaire was used to collect relevant data. Patients were assessed for the severity of periodontitis. A total of 499 DM patients were enrolled in this study. The prevalence of periodontitis was 7.4% among type I DM and 46.4% among type II DM patients. The prevalence of periodontitis was significantly associated with age among type I DM patients (p-value = 0.001) and type II DM patients (p-value = 0.001), respectively, and smoking among type I DM patients (p-value = 0.002) and among type II DM patients (p-value = 0.000), respectively. Age and smoking were the potential associated factors for the prevalence of periodontitis among type I and II DM. The study provides evidence about the prevalence of periodontitis among DM patients, creates awareness regarding the factors that potentially contribute to worsening periodontal tissues, and the importance of early diagnosis and prevention to avoid the irreversible destruction of the periodontal tissues.

Preoperative HbA1c and Blood Glucose Measurements in Diabetes Mellitus before Oral Surgery and Implantology Treatments

Diabetes mellitus has become a worldwide epidemic and is frequently accompanied by a number of complications proportional to the duration of hyperglycemia. The aim of this narrative review is to assess the most up-to-date guidelines on DM provided by both diabetes and dental associations. Furthermore, to gather evidence on the uni/bidirectional relationships of elevated HbA1c levels on dental surgery, implantology, bone augmentation, and periodontology and to demonstrate the importance of measuring HbA1c levels before invasive dental treatments. HbA1c and blood glucose measurements are a minimally invasive method for preventing complications in diabetes mellitus. The authors conducted a literature review to determine which oral conditions are affected by diabetes mellitus. MEDLINE served as a source with the use of a specific search key. Regarding oral complications of diabetes, prevention is the most vital factor. With this publication, we hope to assist physicians and dentists to make prompt diagnoses and to help in recognizing various oral manifestations of diabetes and follow the existing guidelines.

Effect of Nonsurgical Periodontal Therapy on Metabolic Control and Systemic Inflammatory Markers in Patients of Type 2 Diabetes Mellitus with Stage III Periodontitis

Background

A reciprocal relationship is understood to exist between periodontal disease and type 2 diabetes mellitus (T2DM), and this intervention study aimed to evaluate the effects of nonsurgical periodontal therapy (NSPT) on metabolic control, systemic inflammation, and cytokines in patients of T2DM with Stage III periodontitis.

Materials and Methods

Sixty patients of T2DM with Stage III periodontitis were divided equally into two groups: intervention group (IG) and control group. Clinical parameters such as bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline and 3 and 6 months, and the serum samples were collected and processed at baseline and 6 months following NSPT to evaluate fasting plasma glucose, Glycosylated hemoglobin (HbA1c), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), and high-sensitivity capsule-reactive protein (hs-CRP).

Results

The results indicated a significant improvement in clinical parameters of PPD and CAL 6 months after NSPT (P = 0.005) in both the groups. However, a significant decrease (P < 0.0001) in the TNF-α, hs-CRP, blood glucose, and HbA1c levels was seen after NSPT. On the other hand, an increase in anti-inflammatory cytokine IL-10 was observed after NSPT in the IG. The changes in the pretreatment and posttreatment levels of all clinical, biochemical, and metabolic parameters, were found to be significant in both the groups except BOP.

Conclusion

NSPT effectively improves periodontal condition, systemic inflammatory status, and glycemic control in patients of T2DM with Stage III periodontitis and decreases hs-CRP levels.