Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis

Abstract The evidence is inconclusive regarding the effect of periodontal treatment on glycemic control and systemic inflammation in patients with type 2 diabetes (T2D) and periodontitis Objective: To evaluate the effect of scaling and root planing (SRP) on the metabolic control and systemic inflammation of patients with type 2 diabetes (T2D). Methodology: A literature search was conducted using the MEDLINE database via PubMed and the Cochrane Central Register of Controlled Trials, from their oldest records up to July 2018. Only randomized clinical trials (RCT) were considered eligible for evaluating the effect of periodontal treatment on markers of metabolic control [glycated hemoglobin (HbA1C)] and systemic inflammation [C-reactive protein (CRP)] in patients with T2D. The quality of the studies was evaluated using the Cochrane Collaboration risk assessment tool. Meta-analyses were performed for HbA1c and CRP using random effects models. The size of the overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. Heterogeneity was assessed using the Q-statistic method (x2 and I²). The level of significance was established at p<0.05. Results: Nine RCT were included. SRP was effective in reducing HbA1c [DM=0.56 (0.36-0.75); p<0.01] and CRP [DM=1.89 (1.70-2.08); p<0.01]. No heterogeneity was detected (I2=0%, p>0.05). Conclusions: SRP has an impact on metabolic control and reduction of systemic inflammation of patients with T2D.

摘要 目前针对2型糖尿病（type 2 diabetes, T2D）合并牙周炎（periodontitis）患者，牙周治疗（periodontal treatment）对其血糖控制（glycemic control）与全身炎症（systemic inflammation）的影响尚无定论。
目的：评估龈下刮治和根面平整术（scaling and root planing, SRP）对2型糖尿病（T2D）患者代谢控制及全身炎症的影响。
方法：通过PubMed检索MEDLINE数据库及考克兰中央对照试验注册库（Cochrane Central Register of Controlled Trials），检索时限为自建库至2018年7月。仅纳入评估牙周治疗对T2D患者代谢控制指标[糖化血红蛋白（glycated hemoglobin, HbA1C）]与全身炎症指标[C反应蛋白（C-reactive protein, CRP）]影响的随机对照试验（randomized clinical trials, RCT）。采用考克兰协作网风险评估工具（Cochrane Collaboration risk assessment tool）对纳入研究的质量进行评价。采用随机效应模型（random effects models）对HbA1C与CRP数据进行荟萃分析（meta-analyses），通过计算各研究组间均数差（difference in means, DM）的加权平均值来估计整体干预效应的大小。采用Q统计量法（Q-statistic method，χ²与I²）评估异质性，设定显著性水平为p<0.05。
结果：共纳入9项RCT。SRP可有效降低HbA1C水平[DM=0.56（0.36~0.75）；p<0.01]与CRP水平[DM=1.89（1.70~2.08）；p<0.01]，未检测到异质性（I²=0%，p>0.05）。
结论：SRP可改善2型糖尿病（T2D）患者的代谢控制并降低其全身炎症水平。