Umezaki Yojiro, Yamashita Akiko, Nishimura Fusanori, Naito Toru
Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka, Japan.
Department of Periodontology, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.
Front Clin Diabetes Healthc. 2025 Feb 25;6:1541145. doi: 10.3389/fcdhc.2025.1541145. eCollection 2025.
Diabetes mellitus (DM) is linked to complications such as retinopathy, nephropathy, neuropathy, and cardiovascular disease, impacting patient quality of life and increasing healthcare costs. Periodontal disease, more prevalent in diabetic patients, is associated with worsened glycemic control and systemic inflammation, suggesting a possible bidirectional relationship. While some studies indicate periodontal treatment may improve glycemic control and reduce inflammation, overall evidence is inconsistent. It remains unclear if periodontal therapy reliably enhances diabetes outcomes or if certain patient subgroups benefit more than others.
To systematically review randomized controlled trials (RCTs) evaluating the effects of periodontal therapy on glycemic control (HbA1c) and systemic inflammation (CRP) in type 1 and type 2 diabetes patients.
Following PRISMA guidelines, a comprehensive PubMed search identified RCTs comparing HbA1c and CRP outcomes in diabetic patients with periodontal therapy versus controls. Inclusion criteria required at least three to six months of follow-up. Meta-analyses using a random effects model were conducted for HbA1c and CRP changes.
Eleven studies met inclusion criteria. Meta-analyses showed significant reductions in HbA1c at three months (-0.64; CI95%=-0.96 to -0.32; I2 = 73%) and six months (-0.33; CI95%=-0.65 to -0.01; I2 = 12%). CRP also declined significantly, indicating an improvement in systemic inflammation.
Periodontal therapy appears to significantly reduce HbA1c and CRP levels over short-term periods in diabetic patients, suggesting potential as a beneficial adjunct to diabetes management. These findings support incorporating periodontal care into diabetes treatment to reduce systemic inflammation and potentially lower healthcare costs. Future long-term, standardized RCTs are needed to confirm sustained effects and investigate responses in diverse patient populations.
糖尿病（DM）与视网膜病变、肾病、神经病变和心血管疾病等并发症相关，影响患者生活质量并增加医疗成本。牙周疾病在糖尿病患者中更为普遍，与血糖控制恶化和全身炎症有关，提示可能存在双向关系。虽然一些研究表明牙周治疗可能改善血糖控制并减轻炎症，但总体证据并不一致。牙周治疗是否能可靠地改善糖尿病结局，或者某些患者亚组是否比其他患者受益更多，仍不清楚。
系统评价评估牙周治疗对1型和2型糖尿病患者血糖控制（糖化血红蛋白）和全身炎症（C反应蛋白）影响的随机对照试验（RCT）。
遵循PRISMA指南，通过全面的PubMed检索确定了比较接受牙周治疗的糖尿病患者与对照组糖化血红蛋白和C反应蛋白结果的RCT。纳入标准要求至少随访三至六个月。对糖化血红蛋白和C反应蛋白的变化进行随机效应模型的荟萃分析。
11项研究符合纳入标准。荟萃分析显示，三个月时糖化血红蛋白显著降低（-0.64；95%置信区间=-0.96至-0.32；I² = 73%），六个月时（-0.33；95%置信区间=-0.65至-0.01；I² = 12%）也显著降低。C反应蛋白也显著下降，表明全身炎症得到改善。
牙周治疗似乎能在短期内显著降低糖尿病患者的糖化血红蛋白和C反应蛋白水平，提示其作为糖尿病管理有益辅助手段的潜力。这些发现支持将牙周护理纳入糖尿病治疗，以减轻全身炎症并可能降低医疗成本。未来需要长期、标准化的RCT来确认持续效果并研究不同患者群体的反应。
