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. 2019 Aug 6;19(1):176.
doi: 10.1186/s12903-019-0829-y.

Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis

Ruoyan Cao  1 , Qiulan Li  2 , Qiqi Wu  3 , Mianfeng Yao  4 , Yu Chen  1 , Hongbo Zhou  5
Affiliations

Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis

Ruoyan Cao et al. BMC Oral Health. .

Abstract

Background: Glycemic control is vital in the care of type 2 diabetes mellitus (T2DM) and is significantly associated with the incidence of clinical complications. This Bayesian network analysis was conducted with an aim of evaluating the efficacy of scaling and root planning (SRP) and SRP + adjuvant treatments in improving glycemic control in chronic periodontitis (CP) and T2DM patients, and to guide clinical practice.

Methods: We searched the Pubmed, Embase, Cochrane Library and Web of Science databases up to 4 May 2018 for randomized controlled trials (RCTs). This was at least three months of the duration of study that involved patients with periodontitis and T2DM without other systemic diseases given SRP. Patients in the control group did not receive treatment or SRP combination with adjuvant therapy. Outcomes were given as HbA1c% and levels fasting plasma glucose (FPG). Random-effects meta-analysis and Bayesian network meta-analysis were conducted to pool RCT data. Cochrane's risk of bias tool was used to assess the risk of bias.

Results: Fourteen RCTs were included. Most were unclear or with high risk of bias. Compared to patients who did not receive treatment, patients who received periodontal treatments showed improved HbA1c% level, including SRP (the mean difference (MD) -0.399 95% CrI 0.088 to 0.79), SRP + antibiotic (MD 0.62, 95% CrI 0.18 to 1.11), SRP + photodynamic therapy (aPDT) + doxycycline (Doxy) (MD 1.082 95% CrI 0.13 to 2.077) and SRP + laser (MD 0.66 95% CrI 0.1037, 1.33). Among the different treatments, SRP + aPDT + Doxy ranked best. Regarding fasting plasma glucose (FPG), SRP did not show advantage over no treatment (MD 4.91 95% CI - 1.95 to 11.78) and SRP with adjuvant treatments were not better than SRP alone (MD -0.28 95% CI -8.66, 8.11).

Conclusion: The results of this meta-analysis seem to support that periodontal treatment with aPDT + Doxy possesses the best efficacy in lowering HbA1c% of non-smoking CP without severe T2DM complications. However, longer-term well-executed, multi-center trails are required to corroborate the results.

Keywords: Adjuvant therapy; Non-surgical periodontal therapy; Periodontitis; Scaling and root planing; Type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of articles search and screening process
Fig. 2
Fig. 2
Network of the interventional comparisons for the Bayesian network analysis. The size of the nodes is proportional to the number of subjects (sample size) randomized to receive the therapy. The width of the lines is proportional to the number of trials comparing each pair of treatments. aPDT, antimicrobial photodynamic therapy; Doxy, doxycycline; antibiotics (Doxy, metronidazole + amoxicillin); local, locally-delivered drugs (atorvastatin gel, chlorhexidine gel, simvastatin gel); laser (diode laser, aPDT); SDD, subantimicrobial dose doxycycline; SRP, scaling and root planing, NT, no treatment
Fig. 3
Fig. 3
Judgements about each risk of bias item for each included study
Fig. 4
Fig. 4
Multiple-treatment comparisons and the quality of evidence for ΔHbAlc%. aPDT, antimicrobial photodynamic therapy; Doxy, doxycycline; antibiotics (Doxy, metronidazole + amoxicillin); local, locally-delivered drugs (atorvastatin gel, chlorhexidine gel, simvastatin gel); laser (diode laser, aPDT); SDD, subantimicrobial dose doxycycline; SRP, scaling and root planing, NT, no treatment
Fig. 5
Fig. 5
The rank of different treatments. aPDT, antimicrobial photodynamic therapy; Doxy, doxycycline; antibiotics (Doxy, metronidazole + amoxicillin); local, locally-delivered drugs (atorvastatin gel, chlorhexidine gel, simvastatin gel); laser (diode laser, aPDT); SDD, subantimicrobial dose doxycycline; SRP, scaling and root planing, NT, no treatment
Fig. 6
Fig. 6
Publication bias assessment for ΔHbAlc%. aPDT, antimicrobial photodynamic therapy; Doxy, doxycycline; antibiotics (Doxy, metronidazole + amoxicillin); local, locally-delivered drugs (atorvastatin gel, chlorhexidine gel, simvastatin gel); laser (diode laser, aPDT); SDD, subantimicrobial dose doxycycline; SRP, scaling and root planing, NT, no treatment
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