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Effect of periodontal therapy on insulin resistance in adults with dysglycemia and periodontitis: a systematic review and meta-analysis

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Abstract

Objectives

This systematic review and meta-analysis aimed to address whether non-surgical periodontal therapy (NSPT) can affect insulin resistance, estimated by the homeostasis model assessment (HOMA), in adults with prediabetes or type 2 diabetes mellitus and periodontitis.

Materials and methods

Six electronic databases and the gray literature were systematically searched for interventional studies reporting NSPT effect on insulin resistance. Seven studies met the eligibility criteria to be synthesized in the qualitative analysis, six reporting change in HOMA-IR, three reporting change in HOMA-%S, and two in HOMA-β. Among them, four were pooled in a meta-analysis of standardized mean difference (SMD) of HOMA-IR; comparing pre- and post-intervention values, three were pooled considering HOMA-%S as outcome, and two studies were summarized considering SMD of HOMA-%S between intervention and control groups. HOMA-β results were qualitatively synthetized.

Results

With low level of certainty, NSPT significantly reduced HOMA-IR, when compared with pre-intervention data (SMD, −0.35, 95% CI −0.63 to 0.07, p=0.02). There were no significant changes in HOMA-%S or in HOMA-β scores. The level of certainty was very low and moderate, respectively.

Conclusions

Assertions about a causal link between NSPT and insulin resistance are weak and conflicting, although our more robust results point out to the absence of effect. .

Clinical relevance

Because further high-quality studies assessing the relationship between periodontitis and insulin resistance are need, the findings of the current systematic review are limited to give recommendations for clinicians. However, while identifying a lack of research in humans with T2D concerning periodontitis and insulin resistance, this study reinforces the need of multicenter well-designed randomized clinical trials.

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Authors and Affiliations

  1. Department of Dentistry, Faculty of Health Sciences, University of Brasilia, Brasília, Brazil

    Bruna F Greggianin

  2. Laboratory of Oral Histopathology. Department of Dentistry, Faculty of Health Sciences University of Brasilia, Brasília, Brazil

    Ana Elizia M Marques & Caroline L de Lima

  3. Laboratory of Molecular Pharmacology, Department of Pharmaceutical Sciences, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil

    Angélica A Amato & Caroline L de Lima

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  1. Bruna F Greggianin
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Contributions

C.L.L. and B.F.G. contributed to the conception and design of the study, data search and extraction, and the interpretation of the results and drafted the manuscript. A.E.M.M. checked the data search, extraction, and analysis and helped to draft the manuscript. A.A.A. checked data analysis and critically revised the manuscript. C.L.L. and A.A.A. provided important intellectual content to the manuscript. All authors gave final approval of the version to be published.

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Correspondence to Bruna F Greggianin.

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Supplementary information

Supplementary file 1

Table S1. Metabolic and periodontal features of studies’ participants before and after NSPT (DOCX 26.7 KB)

Supplementary file 2

Table S2. Quality assessment according to GRADEpro: level of risk of risk of bias, imprecision, inconsistency, indirect evidence or publication bias (DOCX 17.7 KB)

Supplementary file 3

Appendix S1. Search strategy and date that was performed in the chosen Databases. (DOCX 103 KB)

Supplementary file 4

Figure S1 (DOCX 16 kb)

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Greggianin, B.F., Marques, A.E.M., Amato, A.A. et al. Effect of periodontal therapy on insulin resistance in adults with dysglycemia and periodontitis: a systematic review and meta-analysis. Clin Oral Invest 27, 1329–1342 (2023). https://doi.org/10.1007/s00784-023-04879-6

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