Elsevier

Diabetes & Metabolism

Volume 34, Issue 5, November 2008, Pages 497-506
Diabetes & Metabolism

Original article
Efficacy of periodontal treatment on glycaemic control in diabetic patients: A meta-analysis of interventional studies

https://doi.org/10.1016/j.diabet.2008.03.006Get rights and content

Abstract

Aim

There is growing evidence that periodontal disease may favour the incidence or aggravation of diabetes and its complications. To investigate the issue, we conducted a meta-analysis of the effect of periodontal therapy on glycaemic control in diabetic patients.

Methods

A literature search was carried out using seven databases (Medline, EMBASE, LILACS, The Cochrane Library, Pascal, IADR Abstracts and Current Contents), with no language restrictions. We followed the QUOROM-recommended standards for improving the quality of reporting meta-analyses of interventional studies.

Results

Twenty-five studies, involving 976 subjects altogether, were included in the present systematic review. Of these, nine studies, involving a total of 485 patients, were controlled trials and were included in the meta-analysis. The standardized mean difference in HbA1c with the treatment of periodontal disease was 0.46 (95% CI: 0.11, 0.82). These findings suggest that periodontal treatment could lead to a significant 0.79% (95% CI: 0.19, 1.40) reduction in HbA1c level.

Conclusion

The present meta-analysis represents the best information available to date that addresses this issue, and suggests that periodontal treatment could improve glycaemic control. Nevertheless, these results need to be viewed with caution because of a lack of robustness, and deficiencies in the design of some of the studies included. A randomized controlled trial with sufficient statistical power would help to confirm the results of this meta-analysis.

Résumé

Efficacité du traitement parodontal sur l’équilibre glycémique des sujets diabétiques. Méta-analyse des études interventionnelles.

But

Des études récentes ont montré que la maladie parodontale pourrait avoir un effet néfaste sur l’équilibre glycémique des patients diabétiques. Afin de faire le point sur l’état actuel des connaissances dans ce domaine, nous réalisons une méta-analyse des essais cliniques évaluant l’efficacité d’un traitement parodontal sur le taux d’HbA1c.

Méthodes

La recherche bibliographique porte sur sept bases de données (Medline, EMBASE, LILACS, The Cochrane Library, Pascal, IADR Abstracts, et Current Contents) sans restriction de langue. Les recommandations internationales de bonne pratique de méta-analyse des essais cliniques (QUOROM guidelines) sont suivies.

Résultats

Vingt-cinq études, correspondant à un total de 976 sujets, sont incluses dans ce travail de revue systématique. Parmi ces études, neuf (485 sujets) sont des essais cliniques contrôlés, et peuvent faire l’objet d’une méta-analyse. L’effet standardisé de l’amélioration du taux d’HbA1c à la suite d’un traitement parodontal vaut 0,46, IC 95% [0,11,0,82]. Ce résultat suggère que le traitement parodontal pourrait entraîner une réduction significative de 0,79% du niveau d’HbA1c (IC 95% [0,19,1,40]).

Conclusion

Cette méta-analyse est aujourd’hui la synthèse la plus avancée qu’il est possible de faire, et montre que le traitement des maladies parodontales chez les patients diabétiques peut permettre d’améliorer l’équilibre glycémique. Néanmoins, ces résultats doivent être pris avec précaution, étant donné le manque de robustesse du résultat principal et les biais méthodologiques de quelques études incluses dans la méta-analyse. Un essai clinique réalisé avec suffisamment de puissance serait utile pour confirmer ou non ces résultats.

Section snippets

Abbreviations

    HbA1c

    glycated haemoglobin

    QUOROM

    quality of reporting of meta-analyses

Material and methods

The QUOROM guidelines for meta-analyses of interventional studies were followed at all stages of the meta-analytical process [12].

Trial flow

From the 978 studies initially selected by their titles, we identified 25 interventional studies [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41]. Among these 25, 16 were non-controlled trials and nine were controlled trials. The meta-analysis was performed using the nine controlled studies obtained from seven articles [34], [35], [36], [37], [38], [39], [40], [41] (one article [34] reported on two

Discussion

This extensive literature review shows that the control of periodontal disease could be an important part of the overall management of diabetic patients. Indeed, our meta-analysis of nine controlled studies may lead some to conclude that periodontal therapy may improve glycaemic control. Interpretation of an SMD is less straightforward than interpretation of the original measures of difference between HbA1c levels. To address this problem, back-transforming the SMD (in this case, 0.46) is

Conflict of interest

None to declare.

Acknowledgements

The authors wish to thank: Marie-Cécile Valéra for her assistance with the bibliography searches; Samer Nuwwareh and Alessandra Blaizot for their constructive comments on quality assessment; Wei Yan-Vergnes for assistance with the translation of the Chinese papers; Omid and Manouchehr Naghizadeh for the Persian paper; Susan Becker for her advice on preparing the manuscript; and all of the authors who provided their additional data.

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