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Treating Gum Disease May Help Manage Diabetes

Previous research has indicated that periodontitis often co-exists with diabetes. A study published this week in The Lancet Diabetes and Endocrinology journal went a stage further by suggesting that treating periodontitis could help people with type 2 diabetes manage their blood glucose levels, and could reduce their risk of diabetes-related complications.

A research team from the Eastman Dental Institute at University College London (UCL) said its findings were the first to link intensive gum disease treatment to a reduction in systemic inflammation, and improvements in kidney and blood vessel function.

Whilst acknowledging that further research was needed to establish cause and effect, Professor Francesco D’Aiuto, who led the study, said: "The improvement in blood glucose control we observed, in people who received intensive treatment, is similar to the effect that’s seen when people with type 2 diabetes are prescribed a second blood glucose lowering drug.

"We now need to determine if the improvements we found can be maintained in the longer-term and if they apply to everyone with type 2 diabetes."

Randomised Trial

Researchers carried out a 12 month, single-centre, parallel-group, investigator-masked, randomised trial, involving 264 people with type 2 diabetes and moderate to severe periodontitis. Volunteers had at least 15 teeth and were patients at four hospitals and 15 medical or dental practices in London.

Around half of the participants received intensive gum disease treatment consisting of subgingival scaling and surgical periodontal therapy; the other group received standard care which included supra-gingival scaling and polishing. All treatments took place alongside any type 2 diabetes medications prescribed.

Compared with those in the control periodontal group, patients receiving intensive periodontal treatment exhibited reduced HbA1c after 12 months.

Reducing Inflammation

The study authors said that intensive periodontal treatment "improves metabolic control in patients with type 2 diabetes after 12 months compared with usual care". Additionally, they said: "Reductions in HbA1c and fasting plasma glucose concentrations were accompanied by improved vascular and kidney function, reduced systemic inflammation, and improved quality of life."

The researchers note that periodontitis is a chronic inflammatory disease, which often coexists with diabetes. The accumulation of bacteria on the tooth surface is not confined to the oral cavity but is also associated with an elevated systemic inflammatory response linked to chronic and potentially life-threatening diseases including diabetes, cardiovascular disease, and end-stage renal failure.

Prof John Deanfield, senior investigator of the study at the UCL Institute of Cardiovascular Sciences, said: "Inflammation may be part of the biological pathways that lead to several health conditions including diabetes, heart disease, dementia, and cancer.

"Our findings, that reduction in periodontitis, which is a common cause of inflammation, improves vascular, renal, as well as blood glucose control, in people with type 2 diabetes, are exciting and could lead to new strategies to improve care. Large-scale clinical outcome trials should now be designed."

The researchers said that doctors treating patients with diabetes should discuss the importance of oral health and consider incorporating routine dental care into their treatment plan.

'Important Insight' into Benefits of Oral Health

Dr Elizabeth Robertson, director of research at Diabetes UK which part-funded the study, said: "Currently people with type 2 diabetes aren’t given oral health advice or treatment as part of their routine diabetes care.

"While more work is needed to fully understand how good oral health could help with blood glucose management, this research gives us important insights into the potential benefits of looking after your oral health if you have type 2 diabetes."

In an accompanying Comment article, Pirkko Pussinen and Veikko Salomaa, from the department of Oral and Maxillofacial Diseases at the University of Helsinki, wrote that the study results "could suggest protective effects from both microvascular and macrovascular complications, which are important causes of morbidity and mortality in people with diabetes".

They said further studies or follow-ups were needed "in order to confirm the beneficial effects of intensive treatment of periodontitis in people with diabetes".

Funding was received from Diabetes UK and UK National Institute for Health Research.

Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial, D’Aiuto et al, Lancet Diabetes Endocrinol. Full text.

Oral health: a neglected aspect of diabetes care, Pussinen, Salomaa, Comment, Lancet Diabetes Endocrinol. Abstract.