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      Treatment of periodontal disease for glycaemic control in people with diabetes mellitus

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          Abstract

          Glycaemic control is a key issue in the care of people with diabetes mellitus (DM). Periodontal disease is the inflammation and destruction of the underlying supporting tissues of the teeth. Some studies have suggested a bidirectional relationship between glycaemic control and periodontal disease. This review updates the previous version published in 2010.

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          Periodontal disease and diabetes mellitus: a two-way relationship.

          Sara Grossi, Robert J. Genco (1998)
          Severe periodontal disease often coexists with severe diabetes mellitus. Diabetes is a risk factor for severe periodontal disease. A model is presented whereby severe periodontal disease increases the severity of diabetes mellitus and complicates metabolic control. We propose that an infection-mediated upregulation cycle of cytokine synthesis and secretion by chronic stimulus from lipopolysaccharide (LPS) and products of periodontopathic organisms may amplify the magnitude of the advanced glycation end product (AGE)-mediated cytokine response operative in diabetes mellitus. In this model, the combination of these 2 pathways, infection and AGE-mediated cytokine upregulation, helps explain the increase in tissue destruction seen in diabetic periodontitis, and how periodontal infection may complicate the severity of diabetes and the degree of metabolic control, resulting in a 2-way relationship between diabetes mellitus and periodontal disease/infection. This proposed dual pathway of tissue destruction suggests that control of chronic periodontal infection is essential for achieving long-term control of diabetes mellitus. Evidence is presented to support the hypothesis that elimination of periodontal infection by using systemic antibiotics improves metabolic control of diabetes, defined by reduction in glycated hemoglobin or reduction in insulin requirements.
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            Tests of glycemia in diabetes.

            D E Goldstein, R. Little, R. A. Lorenz … (2004)
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              Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of european prospective investigation of cancer and nutrition (EPIC-Norfolk).

              Ailsa A. Welch, R. Luben, Jeremy Day … (2001)
              To examine the value of glycated haemoglobin (HbA(1c)) concentration, a marker of blood glucose concentration, as a predictor of death from cardiovascular and all causes in men. Prospective population study. Norfolk cohort of European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk). 4662 men aged 45-79 years who had had glycated haemoglobin measured at the baseline survey in 1995-7 who were followed up to December 1999. Mortality from all causes, cardiovascular disease, ischaemic heart disease, and other causes. Men with known diabetes had increased mortality from all causes, cardiovascular disease, and ischaemic disease (relative risks 2.2, 3.3, and 4.2, respectively, P /=7%, or history of myocardial infarction or stroke were excluded. 18% of the population excess mortality risk associated with a HbA(1c) concentration >/=5% occurred in men with diabetes, but 82% occurred in men with concentrations of 5%-6.9% (the majority of the population). Glycated haemoglobin concentration seems to explain most of the excess mortality risk of diabetes in men and to be a continuous risk factor through the whole population distribution. Preventive efforts need to consider not just those with established diabetes but whether it is possible to reduce the population distribution of HbA(1c) through behavioural means.
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                Author and article information

                Journal
                Journal ID (publisher-id): 146518
                Title: Cochrane Database of Systematic Reviews
                Publisher: Wiley
                ISSN (Electronic): 14651858
                Publication date (Electronic): November 06 2015
                Affiliations
                [1 ]University of Edinburgh; Edinburgh Dental Institute; Lauriston Place Edinburgh Scotland UK EH3 8HA
                [2 ]Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; Cochrane Oral Health; JR Moore Building Oxford Road Manchester UK M13 9PL
                [3 ]UCL Eastman Dental Institute; Unit of Periodontology and International Centre for Evidence-Based Oral Health; 256 Gray's Inn Road London UK WC1X 8LD
                [4 ]Public Health Sciences, University of Edinburgh; Centre for Public Health and Primary Care Research; Teviot Place Edinburgh UK EH8 9AG
                [5 ]Peninsula Dental School; Oral Health Services Research; The John Bull Building, Tamar Science Park, Research Way Plymouth UK PL6 8BU
                [6 ]University of Dundee Dental Hospital and School; Department of Restorative Dentistry; Park Place Dundee Tayside UK DD1 4HN
                [7 ]University of Central Lancashire; School of Medicine; Harrington Building Preston, Lancashire UK
                Article
                DOI: 10.1002/14651858.CD004714.pub3
                PMC ID: 6486035
                PubMed ID: 26545069
                SO-VID: 4775d538-e369-4469-b3c5-a23ff2055232
                Copyright © © 2015
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