Department of Prosthodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, 72 Xiangya Road, Changsha, 410000, China.
Department of Stomatology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China.
BMC Oral Health. 2019 Aug 6;19(1):176. doi: 10.1186/s12903-019-0829-y.
Glycemic control is vital in the care of type 2 diabetes mellitus (T2DM) and is significantly associated with the incidence of clinical complications. This Bayesian network analysis was conducted with an aim of evaluating the efficacy of scaling and root planning (SRP) and SRP + adjuvant treatments in improving glycemic control in chronic periodontitis (CP) and T2DM patients, and to guide clinical practice.
We searched the Pubmed, Embase, Cochrane Library and Web of Science databases up to 4 May 2018 for randomized controlled trials (RCTs). This was at least three months of the duration of study that involved patients with periodontitis and T2DM without other systemic diseases given SRP. Patients in the control group did not receive treatment or SRP combination with adjuvant therapy. Outcomes were given as HbA1c% and levels fasting plasma glucose (FPG). Random-effects meta-analysis and Bayesian network meta-analysis were conducted to pool RCT data. Cochrane's risk of bias tool was used to assess the risk of bias.
Fourteen RCTs were included. Most were unclear or with high risk of bias. Compared to patients who did not receive treatment, patients who received periodontal treatments showed improved HbA1c% level, including SRP (the mean difference (MD) -0.399 95% CrI 0.088 to 0.79), SRP + antibiotic (MD 0.62, 95% CrI 0.18 to 1.11), SRP + photodynamic therapy (aPDT) + doxycycline (Doxy) (MD 1.082 95% CrI 0.13 to 2.077) and SRP + laser (MD 0.66 95% CrI 0.1037, 1.33). Among the different treatments, SRP + aPDT + Doxy ranked best. Regarding fasting plasma glucose (FPG), SRP did not show advantage over no treatment (MD 4.91 95% CI - 1.95 to 11.78) and SRP with adjuvant treatments were not better than SRP alone (MD -0.28 95% CI -8.66, 8.11).
The results of this meta-analysis seem to support that periodontal treatment with aPDT + Doxy possesses the best efficacy in lowering HbA1c% of non-smoking CP without severe T2DM complications. However, longer-term well-executed, multi-center trails are required to corroborate the results.
血糖控制对于 2 型糖尿病（T2DM）的治疗至关重要，与临床并发症的发生显著相关。本贝叶斯网络分析旨在评估牙周基础治疗（SRP）和 SRP+辅助治疗在改善慢性牙周炎（CP）和 T2DM 患者血糖控制方面的疗效，为临床实践提供指导。
我们检索了 Pubmed、Embase、Cochrane 图书馆和 Web of Science 数据库，截至 2018 年 5 月 4 日，以获取涉及牙周炎和 T2DM 患者的随机对照试验（RCT）。研究时间至少为三个月，包括接受 SRP 的牙周炎和 T2DM 患者，但不伴有其他系统性疾病。对照组患者未接受治疗或 SRP 联合辅助治疗。结局为糖化血红蛋白（HbA1c%）和空腹血糖（FPG）水平。采用随机效应荟萃分析和贝叶斯网络荟萃分析对 RCT 数据进行合并。采用 Cochrane 偏倚风险工具评估偏倚风险。
纳入了 14 项 RCT。大多数研究的偏倚风险为不清楚或高。与未接受治疗的患者相比，接受牙周治疗的患者 HbA1c%水平得到改善，包括 SRP（平均差[MD]-0.399，95%置信区间[CrI]0.088 至 0.79）、SRP+抗生素（MD 0.62，95%CrI 0.18 至 1.11）、SRP+光动力疗法（aPDT）+多西环素（Doxy）（MD 1.082，95%CrI 0.13 至 2.077）和 SRP+激光（MD 0.66，95%CrI 0.1037，1.33）。在不同的治疗方法中，SRP+aPDT+Doxy 的效果最佳。关于空腹血糖（FPG），SRP 并不优于不治疗（MD 4.91，95%置信区间[-1.95，11.78]），而 SRP 联合辅助治疗并不优于单独 SRP（MD-0.28，95%置信区间[-8.66，8.11]）。
本荟萃分析结果似乎支持在不伴有严重 T2DM 并发症的非吸烟 CP 患者中，采用 aPDT+Doxy 的牙周治疗对降低 HbA1c%的效果最佳。然而，需要进行更长时间、多中心的试验来证实这些结果。
