Impact of Diabetes on Clinical Outcomes of Non-Surgical Periodontal Therapy
Objectives: Diabetes is a risk factor for periodontal diseases. In the treatment of periodontal infection, impaired tissue healing due to glycemic control has been a great concern for the clinicians. This meta-analysis aimed to evaluate the impact of diabetes on non-surgical treatment outcomes of chronic periodontitis since limited clinical evidence is available. Methods: Searches were conducted in several electronic databases, including MEDLINE (PubMed), EMBASE, Scopus and ClinicalTrials.gov to screen studies published from January 1960 to July 2017. The included studies should be prospective cohort studies, enrolling at least two groups of patients who have either chronic periodontitis only (P group) or both diabetes and chronic periodontitis (DMP group). Outcomes of interests included changes of probing depth (PD) and clinical attachment level (CAL) after non-surgical periodontal therapy between the two groups. Meta-analysis was performed using either a random-effects model or a fixed-effects model, depending on the results of heterogeneity. Meta-regression was also conducted to evaluate the correlation between the outcomes of interests and possible confounding factors. Results: A total of 12 studies enrolling 491 participants were included. Both DMP and P groups showed significant improvements in PD reduction and CAL gain compared with baseline. However, there was no significant difference in PD reduction (p=0.55) or CAL gain (p=0.65) in the comparison between DMP and P groups. Further meta-retrogression analysis showed a positive association between PD reduction after treatments and PD differences at baseline (p=0.03) despite the HbA1C level did not significantly affect the clinical outcomes. Conclusions: Non-surgical periodontal therapy benefits the PD reduction and CAL gain in both patients with or without diabetes. Diabetes does not seem to be a significant factor affecting the outcomes of non-surgical periodontal treatments within six months. Further studies are needed to evaluate the long-term impacts of diabetes on periodontal therapy