Glycemic control and adipokines after periodontal therapy in patients with Type 2 diabetes and chronic periodontitis

Abstract: The mechanism by which chronic periodontitis (CP) affects type 2 diabetes (T2DM) remains unclear. Therefore, the aim of this study is to evaluate the effects of periodontal therapy (PT) on the glycemic control and adipokines of patients with T2DM and CP with the purpose of elucidating the possible mechanisms by which CP influences T2DM. Forty-four patients with T2DM and CP were randomly divided into two groups according to whether they underwent PT. Periodontal status, blood glucose, and the levels of serum tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), adiponectin (APN), and fibroblast growth factor-21 (FGF-21) were measured at baseline and after 3 months. The results revealed that the probing depth (PD) and attachment loss (AL) were significantly improved, the serum levels of TNF-α and IL-6 were significantly decreased, and APN and FGF-21 exhibited substantial increases in the intervention group after 3 months (p < 0.05), whereas no significant changes were observed in the control group. The glycated hemoglobin (HbA1c) levels in both groups decreased significantly after 3 months compared with baseline (p < 0.05), but the intervention group exhibited a significantly greater change (p < 0.05). In conclusion, PT may relieve periodontal inflammation, which causes a reduction of insulin-antagonizing adipokines and an increase in insulin-sensitizing adipokines, thereby eliciting an improvement in glycemic control.

摘要：慢性牙周炎（chronic periodontitis，CP）影响2型糖尿病（type 2 diabetes，T2DM）的具体机制目前仍不明确。因此，本研究旨在评估牙周治疗（periodontal therapy，PT）对合并慢性牙周炎的2型糖尿病患者血糖控制及脂肪因子的影响，以阐明慢性牙周炎影响2型糖尿病的潜在机制。本研究共纳入44例合并慢性牙周炎的2型糖尿病患者，根据是否接受牙周治疗随机分为两组。分别于基线及干预3个月后检测受试者的牙周状态、血糖水平，以及血清肿瘤坏死因子α（tumor necrosis factor α，TNF-α）、白细胞介素6（interleukin-6，IL-6）、脂联素（adiponectin，APN）和成纤维细胞生长因子21（fibroblast growth factor-21，FGF-21）水平。结果显示，干预组患者在3个月后探诊深度（probing depth，PD）与附着丧失（attachment loss，AL）均得到显著改善，血清TNF-α、IL-6水平显著降低，APN与FGF-21水平显著升高（p < 0.05）；而对照组未观察到显著变化。两组患者的糖化血红蛋白（glycated hemoglobin，HbA1c）水平在3个月后均较基线显著降低（p < 0.05），但干预组的改善幅度更为显著（p < 0.05）。综上，牙周治疗可缓解牙周炎症，通过降低胰岛素拮抗型脂肪因子水平、升高胰岛素敏感型脂肪因子水平，从而改善患者的血糖控制情况。