Effect of periodontitis treatment on glycated hemoglobin A1c (HbA1c) levels in patients with type 2 diabetes mellitus: a systematic review

Relevance. Diabetes mellitus (DM) ranks as the most prevalent non-communicable chronic disease worldwide, associated with severe complications, high mortality, and significant disability. One of these complications is systemic angiopathy, which includes angiopathy of the periodontal tissues and contributes to the development of periodontitis. The prevalence of inflammatory periodontal diseases in individuals with DM reaches 98%. Substantial evidence supports a bidirectional association between periodontitis and type 2 diabetes (T2DM), which accounts for 95% of all DM cases. Since hyperglycemia adversely affects periodontal health, regular monitoring of glycated hemoglobin A1c (HbA1c)—the gold standard for assessing glycemic control in patients with diabetes—is critical. Several researchers have also reported that treatment of chronic periodontitis improves glycemic status and may may help maintain consistently lower HbA1c levels.

Objective. To synthesize, qualitatively analyze, and summarize findings from previously published studies investigating the effect of periodontitis treatment on HbA1c levels in adults with diagnosed type 2 diabetes mellitus.

Materials and methods. A literature search was performed across PubMed, eLIBRARY, supplemented by snowball sampling of references. The search encompassed publications from 2009 to September 2024. Inclusion criteria were restricted to randomized controlled trials involving adult T2DM patients that assessed HbA1c level changes following periodontitis treatment. Methodological quality was appraised using the Cochrane Risk of Bias Tool for Randomized Trials.

Results. The initial search yielded 226 records. After duplicate removal, title/abstract screening, and full-text assessment, eight studies met the eligibility criteria. The mean baseline HbA1c level across participants was ≥7.06%.

Conclusion. All studies reported a reduction in mean HbA1c levels in the treatment group six months after treatment of periodontitis. This review supports the hypothesis that non-surgical treatment of periodontitis (scaling and root planing, SRP) combined with optimized oral hygiene can lower HbA1c in T2DM patients. However, further high-quality randomized controlled trials are required to assess the efficacy of combining non-surgical treatment methods with adjunctive pharmacological interventions for periodontitis.

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