Effects of non-surgical periodontal treatment on the blood pressure profile and glycemic control in type 2 diabetes patients

Njeatih Linda Umeyugho Nzometia
Buccodental Medicine; Periodontology; Diabetology, University of Yaounde I
June, 2018


Background and rationale: Diabetes is a global emergency and a leading cause of mortality worldwide due to its complications and cardiovascular events. Its frequent association with high blood pressure further worsens the prognosis. The association between diabetes mellitus, high blood pressure and cardiovascular diseases is underlain by chronic low grade inflammation. Periodontal diseases, a frequent complication of type 2 diabetes mellitus (T2DM), may be a major contributing factor. Periodontal diseases and diabetes mellitus are two clinical entities which reciprocally influence one another. While it is known that the treatment of periodontal diseases improves glycemic control, it is still unclear whether such treatment would have a similar effect on blood pressure profile by decreasing low grade inflammation.
Objective: The main objective of the study was to evaluate the effect of non-surgical periodontal treatment on 24-hour blood pressure profiles and glycemic control in T2DM patients with elevated office based blood pressure measurement at the National Obesity Center (NOC) of the Yaoundé Central Hospital.
Methods: This study was a non-randomized clinical trial with a before-after design where each participant was his or her own control. Thirty participants were enrolled and allocated treatment. The intervention consisted of non-surgical periodontal scaling and root planning. In each participant, we assessed at baseline and twelve-weeks afterwards: 24-hour blood pressure profile, glycated hemoglobin (HbA1c), fasting blood glucose, periodontal parameters and high sensitive C-reactive protein (hs-CRP). Data was analyzed using SPSS version 20.0. Descriptive and inferential statistics were used. Categorical variables were compared using Chi square. All p values < 0.05 were considered significant. Non-parametrical statistical tests were used such as Wilcoxon signed rank test to compare variables before and after the intervention.
Results: Thirty patients (13 males and 17 females), aged 55 [50-62] years, with known T2DM for 6 [2-10] years, a mean HbA1c level of 7.59 ± 2.61 and office blood pressure of 131.01 ± 10.60 for systolic and 80.48 ± 7.74 for diastolic participated in this study. Among them, 17 (56.7%) had severe periodontitis and 13 (43.3%) had moderate periodontitis. Non-surgical periodontal treatment resulted in a significant improvement in periodontal parameters. The mean plaque index decreased from 70.10 ± 20.88 % to 41.42 ± 18.56 % (p < 0.001), the average probing depth from 1.87 ± 0.43mm to 1.44 ± 0.33mm (p < 0.001) and a significant decrease in bleeding index from 20.01 ± 15.28 % to 9.51 ± 12.38 % (p = 0.001). Office based blood pressure significantly dropped from 131.01 ± 10.60 mmHg to 125.25 ± 13.81mmHg (p = 0.010) for systolic and 80.48 ± 7.74 to 72.28 ± 9.07 mmHg (p = < 0.001) for diastolic. Blood pressure profiles obtained after ABPM showed: no significant change in average 24h systolic blood pressure from 124.33 ± 9.69mmHg to 124.43 ± 9.88 mmHg (p = 0.950), 24h diastolic blood pressure from 75.23 ± 7.82 mmHg to 75.07 ± 8.82 mmHg (p = 0.915). As concerns evaluation of nychthemeral variation of blood pressure profiles, there was a non-significant reduction in systolic night time blood pressure depression from 4.24 ± 6.68 % to 2.95 ± 8.49 % (p = 0.289) and a non-significant increase in diastolic night time blood pressure depression from 5.37 ± 8.71 % to 5.87 ± 9.11 % (p = 0.728). HbA1c levels significantly decreased from 7.6 ± 2.61 % to 6.26 ± 1.44 % (p = 0.005). There was also a non-significant increase in serum CRP from 3.64 ± 5.42 mg/l to 3.86 ± 5.37 mg/l (p = 0.079).
Conclusion: Non-surgical periodontal treatment of periodontitis significantly improved glycemic control in T2DM patients and therefore plays an important role in decreasing diabetes related morbidity. However, there was no change in 24hr systolic and diastolic blood pressure profiles, despite the reduction in office based systolic and diastolic blood pressures.