The impact of periodontal therapy on clinical and inflammatory parameters in type II diabetics

BACKGROUND: An association between periodontal disease and diabetes exists, although the mechanisms associated with treatment response and glycemic control are not fully elucidated. The goals of this study were to evaluate the clinical response, local (gingival crevicular fluid - GCF) and systemic (serum) inflammatory and metabolic profile following periodontal treatment of type II diabetic subjects. METHODS: Forty-two type II diabetic subjects with hemoglobin A1C (HbA1c) > 6.5 and periodontitis were evaluated following non-surgical periodontal treatment. Periodontal parameters (e.g., pocket depth - PD, clinical attachment level - CAL, and bleeding on probing - BoP), HbA1c, local and systemic inflammatory mediators were evaluated at baseline, 3, 6, and 12 months. RESULTS: All periodontal parameters were reduced post-treatment (p < 0.001). Although HbA1c levels were not reduced post-treatment (p = 0.515), they were positively associated with baseline PD > 4 mm and BoP as well as with PD/CAL and PD > 4 mm reductions. Both local and systemic inflammatory profiles were modulated post-treatment (p < 0.05), with local reductions of INF-γ, IL-10, IL-12p40, MIP-1α, and GM-CSF at 3 months (p < 0.05), and systemic Eotaxin at 12 months. Other systemic markers increased post-treatment. HbA1c was associated with local IL-1β and systemic Eotaxin reductions (p < 0.05). CONCLUSIONS: Uncontrolled diabetic subjects showed a positive clinical response and differentiated local and systemic profile post-treatment, where local markers were reduced in the short-term and several systemic markers increased. Although HbA1c was not reduced post-treatment, it was associated with clinical and some inflammatory response. CLINICALTRIALS: gov ID NCT01881074.