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. 2021 Feb 15;55(1):57-67.
eCollection 2021 Feb.

An umbrella review of systematic reviews examining the relationship between type 2 diabetes and periodontitis: Position paper from the Canadian Dental Hygienists Association

Salme E Lavigne  1 , Jane L Forrest  2
Affiliations

An umbrella review of systematic reviews examining the relationship between type 2 diabetes and periodontitis: Position paper from the Canadian Dental Hygienists Association

Salme E Lavigne et al. Can J Dent Hyg. .

Abstract
in English, French

Previous research has confirmed strong associations between periodontitis and diabetes mellitus (DM), supporting DM as a risk factor for periodontal disease and suggesting a bidirectional relationship. Causal relationships have not been confirmed.

Aim: The aim of this paper is to review the most current evidence of the nature of this relationship and examine whether non-surgical periodontal therapy (NSPT) significantly lowers glycemic (HbA1c) control.

Methods: The PICO question was, "For individuals with type 2 diabetes mellitus (T2DM) and periodontitis, will non-surgical periodontal therapy (NSPT), as compared to no treatment, improve the individual's glycemic control as measured by HbA1c." Only systematic reviews (SRs) with or without a meta-analysis (MA) of randomized controlled trials (RCTs) or umbrella reviews of SRs and MAs of RCTs published in the English language between 2007 and 2019 were included. Several databases were searched as per their protocols. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality.

Results: Of 54 records retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 5 SRs/MAs and 3 umbrella reviews of SRs/MAs were selected. All 5 SRs/MAs reported reductions in HbA1c levels 3 months following NSPT, but effect sizes were small and 2 were not statistically significant. The 3 umbrella reviews consistently reported small reductions in HbA1c, but high levels of heterogeneity and moderate to high risk of bias. The Bradford Hill criteria failed to support a causal relationship between periodontitis and T2DM.

Conclusions: Whether NSPT compared with no treatment in persons with T2DM improves the individual HbA1c remains unclear as does the exact nature of the relationship between periodontitis and T2DM.

La recherche précédente a confirmé de fortes associations entre la maladie parodontale et le diabète sucré (DS), appuyant le DS comme facteur de risque de la maladie parodontale, et la suggestion d’un lien bidirectionnel. Des associations causales n’ont pas été confirmées.

Objectif: Le présent document vise à examiner les données probantes les plus actuelles pour examiner la nature de ce lien et déterminer si la thérapie parodontale non chirurgicale (TPNC) diminue considérablement la régulation glycémique (HbA1c).

Méthodologie: La question PICO était : « Les personnes souffrant de diabète sucré de type 2 (DST2) et de parodontite verront-elles une amélioration de leur régulation glycémique, telle que mesurée par la HbA1c, s’ils ont une thérapie parodontale non chirurgicale (TPNC) par rapport à ne pas obtenir de traitement? » Seules les revues systématiques (RS) avec méta-analyses (MA) d’essais contrôlés randomisés (ECR) ou des examens-cadres de RS/MA d’ECR publiés en anglais entre 2007 et 2019 ont été inclus. Les recherches ont été effectuées dans plusieurs banques de données selon leurs protocoles respectifs. Des évaluations de la qualité ont été effectuées par les 2 auteures au moyen de la liste de vérification PRISMA. Les critères de Bradford Hill ont été utilisés pour déterminer les preuves de causalité.

Résultats: Parmi les 54 dossiers repérés après l’élimination des doubles et des études qui ne répondaient pas aux critères d’inclusion, 5 RS/MA et 3 examens-cadres de RS/MA ont été sélectionnés. Les 5 RS/MA ont tous indiqué des réductions dans les niveaux de la HbA1c, 3 mois après la TPNC, mais l’ampleur de l’effet était faible et 2 d’entre elles n’étaient pas statistiquement significatives. Les 3 examens-cadres ont indiqué de façon uniforme de petites réductions dans la HbA1c, malgré des taux élevés d’hétérogénéité et un risque de biais de modéré à élevé . Les critères de Bradford Hill n’ont pas réussi à appuyer une relation causale entre la parodontite et le DST2.

Conclusions: Il n’est toujours pas clair si la TPNC chez les personnes souffrant de DST2 améliore leur HbA1c, par rapport à ne recevoir aucun traitement, comme demeure inconnue la nature exacte du lien entre la parodontite et le DST2.

Keywords: diabetes mellitus; meta-analysis; non-surgical periodontal treatment or therapy; periodontal disease; periodontitis; systematic reviews; type 2 diabetes (T2DM).

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Conflict of interest statement

The authors have declared no conflicts of interest.

Figures

Figure 1.
Figure 1.
Diabetes search flow diagram
See this image and copyright information in PMC

References

    1. Public Health Agency of Canada (PHAC).Diabetes in Canada: Highlights from the Canadian Chronic Disease Surveillance System. Cat.: HP35-94/2017E-PDF | ISBN: 978-0-660-23635-3 | Pub.: 170260
    1. Borgnakke WS, Ylöstalo PV, Taylor GW, Genco RJ Effect of periodontal disease on diabetes: Systematic review of epidemiological observational evidence J Periodontol 2013;84(4 Suppl):S135–S152 - PubMed
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    1. Genco RJ, Graziani F, Hasturk H Effects of periodontal disease on glycemic control, complications, and incidence of diabetes mellitus Periodontology 2000 2020;83:59–65 - PubMed

Excluded studies

    1. Abariga SA, Whitcomb BW Periodontitis and gestational diabetes mellitus: A systematic review and meta-analysis of observational studies BMC Pregnancy Childbirth 2016;16(1):344 - PMC - PubMed
    1. Borell LN, Joseph SP Periodontal treatment may control glycemic status among diabetic patients J Evid Base Dent Pract 2011;11:92–94 - PubMed
    1. Boyd L, Giblin L, Chadbourne D Bidirectional relationship between diabetes mellitus and periodontal disease: state of the evidence Can J Dent Hyg 2012;46(2):93–102
    1. Cao R, Li Q, Wu Q, Yao M, Chen Y, Zhou H Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis BMC Oral Health 2019;19:176 - PMC - PubMed
    1. Darré L, Vergnes J-N, Gourdy P, Sixou M Efficacy of periodontal treatment on glycaemic control in diabetic patients: A meta-analysis of interventional studies Diabetes Metab 2008;34:497–506 - PubMed

Cited within the manuscript but excluded from analysis

    1. Borgnakke WS, Ylöstalo PV, Taylor GW, Genco RJ Effect of periodontal disease on diabetes: Systematic review of epidemiological observational evidence J Periodontol 2013;84(4 Suppl ):S135–S152 - PubMed
    1. Engebretson S, Kocher T Evidence that periodontal treatment improves diabetes outcomes: A systematic review and meta-analysis J Clin Periodontol 2013;40(Suppl 14):S153–S163 - PubMed
    1. Teeuw WJ, Gerdes VEA, Loos BG Effect of periodontal treatment on glycemic control of diabetic patients Diabetes Care 2010;33(2):421–427 - PMC - PubMed
    1. Wang T-F, Jen I-A, Chou C, Lei Y-P Effects of periodontal therapy on metabolic control in patients with type 2 diabetes mellitus and periodontal disease: A meta-analysis Medicine (Baltimore) 2014;93(28):e292 - PMC - PubMed

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