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Randomized Controlled Trial
. 2025 Jul 2;25(1):1065.
doi: 10.1186/s12903-025-06462-9.

Levels of peripheral CD4 + and CD8 + T cells and glycaemic control level in patients with both type 2 mellitus diabetes and stage III-IV periodontitis: a randomized controlled trial in Chinese population

Yadan Fan  1 , Zhikai Lin  1 , Lan Cheng  1 , Linhua Ge  2
Affiliations
Randomized Controlled Trial

Levels of peripheral CD4 + and CD8 + T cells and glycaemic control level in patients with both type 2 mellitus diabetes and stage III-IV periodontitis: a randomized controlled trial in Chinese population

Yadan Fan et al. BMC Oral Health. .

Abstract

Objective: The aim of this randomized controlled trial was to investigate the short-term glycated haemoglobin (HbA1c) level and proportional variation of peripheral T-lymphocytes status after subgingival scaling and root planing (SRP) therapy in patients with type 2 diabetes mellitus(T2DM) and stage III-IV periodontitis in Chinese population.

Methods: Fifty-one participants diagnosed T2DM and stage III-IV periodontitis were enrolled. Twenty-seven of them were randomly assigned to receive SRP + OHI treatment immediately and twenty-four only receive OHI and the delayed SRP treatment. Additionally, we divided participants into two stratifications according to initial HbA1c levels. The HbA1c values, proportion of peripheral CD4 + and CD8 + T-lymphocytes, CD4+/CD8 + ratio, and periodontal parameters: plaque index (PI), percentage of bleeding on probing (BOP%), pocket depth (PD) and clinical attachment level (CAL) were measured at baseline, 3 and 6 months.

Results: Forty-eight participants completed the course of our study. At 6-month follow-up, the HbA1c reduction of SRP + OHI group is 0.22 ± 1.12%, greater than 0.07 ± 0.83% of OHI group(P = 0.592). When HbA1c ≥ 7.5%, the HbA1c reduction of SRP + OHI group is 0.74 ± 1.68%, comparing to 0.43 ± 0.91% of OHI group(P = 0.627); when HbA1c < 7.5%, the reductions were - 0.09 ± 0.39 and - 0.17 ± 0.70 respectively(P = 0.716). Both groups showed a slight decrease of peripheral CD4+/CD8 + ratio at 6-month revaluation. An 0.12 ± 0.08 increase of CD4+/CD8 + ratio was observed in SRP + OHI group when HbA1c ≥ 7.5%, which was significantly different to the conrol group(P = 0.040). As to periodontal parameters, PI, BOP% and PD were significantly improved after treatment, while the intergroup analysis in HbA1c ≥ 7.5% group showed no significant reduction of the PI and BOP% s at 6-months.

Conclusion: Participants under hyperglycemia (HbA1c ≥ 7.5%) and stage III-IV periodontitis exhibited higher sensitivity of HbA1c level to SRP treatment. When HbA1c ≥ 7.5%, The peripheral CD4+/CD8 + ratio showed a slight increase in the intervention group while only reduction was found in other groups. And the peripheral CD4+/CD8 + ratio of SRP + OHI group in the HbA1c ≥ 7.5% stratification showed a significant increase while other subgroups all present a subtle decrease.

Keywords: CD4+/CD8 + ratio; Periodontitis; Scaling and root planing; Type 2 diabetes.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Our research was granted approval by the institutional ethical committee of the Ninth People’s Hospital Affiliated to Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine (Approval number: SH9H-2019-T208-1), and the study was registered with the clinical trial registry, China (ChiCTR2000029251, 2020-01-20). Informed consent was well understood and signed by all participants. All methods were carried out in accordance with relevant standard guidelines and regulations. Consent for publication: Informed written consent was taken from trial participants before history taking, examination and trial procedure at baseline as well as at each follow-up. All methods were carried out in accordance with relevant standard guidelines and regulations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
HbA1c level, CD4+/CD8+ ratio and periodontal parameters at baseline and follow-ups(mean ± SE). P value: Intra-group mean values comparison between baseline and each follow-up reading, all analyzed by t-test. SRP, scaling root planing; OHI, oral hygiene instructions
Fig. 2
Fig. 2
HbA1c level, CD4+/CD8+ ratio and periodontal parameters at baseline and follow-ups(mean ± SE). P value: Intra-group mean values comparison between baseline and each follow-up reading, all analyzed by t-test. SRP, scaling root planing; OHI, oral hygiene instructions
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