Glycemic Control in Type-2 Diabetes Mellitus Patients Through Non-Surgical Periodontal Therapy: A Randomized Controlled Trial
Overview
- Phase
- Phase 2
- Intervention
- Metronidazole
- Conditions
- Chronic Periodontitis
- Sponsor
- Dow University of Health Sciences
- Enrollment
- 150
- Locations
- 1
- Primary Endpoint
- Glycated Hemoglobin (HbA1c)
- Status
- Completed
- Last Updated
- 5 years ago
Overview
Brief Summary
It is submitted that incident and prevalent chronic periodontal infection, known as chronic periodontitis (CP) possibly has a causal relationship with diabetes mellitus (DM) having effects on HbA1c, fasting plasma/ blood glucose (FPG/ FBG) and fasting plasma insulin (FPI) levels. Experimental research has suggested that treating CP may improve glycemic control and insulin resistance in Non-Insulin Dependent Type-2 DM patients (T2DM). However, there is limited data concerning the need and effects of adjunct antibiotic therapy (AAT) along with scaling root planning (SRP) in treating CP for long lasting results. Therefore, it is suggested that further research with larger samples must be undertaken for a successful periodontal therapy that may help improve glycemic control at desired levels and longer durations. This study is designed to evaluate effects of periodontal therapy [SRP, metronidazole (MET) and oral hygiene instructions (OHI)] through three-arm trial experiment comprising of SRP+MET+OHI, SRP+OHI and OHI+ Delayed Therapy (DT) groups on HbA1c, FBG, FPI levels and Insulin Resistance calculated through Homeostasis Model Assessment (HOMA-IR) to fill research gap. This study will target large number of individuals (N > 1000) at trial camps known as diabetes-periodontitis (Diab-Per) camps at three different campuses of Dow University of Health Sciences hospitals to be screened for presence of signs and symptoms of chronic periodontitis and type-2 diabetes Mellitus. The selected candidates will be referred to the base camp for further evaluation to be enrolled in trial and recruit 150 participants randomly allocated in each group (50 in each group). Post-therapy follow-up results will be assessed at 1, 3 and 6 months to evaluate short and long term changes in status of CP, FBG, FPI and HbA1c.
Detailed Description
The overall evidence that CP has a role in the causal pathway of DM is yet limited and inconsistent. Although intervention research has suggested that treating CP may improve glycemic control and insulin resistance in Type-2 DM patients; yet there is limited data concerning the effects of adjunct antibiotic therapy (AAT) in addition to scaling root planning (SRP) in treating CP for long lasting results. Therefore, it is suggested that further research with bigger samples must be undertaken for a successful periodontal therapy that may help improve glycemic control at desired levels and long durations. This study is designed to evaluate the effects of periodontal therapy \[SRP, metronidazole (MET) and oral hygiene instructions (OHI)\] through a three-arm trial comprising of SRP+MET+OHI group, SRP+OHI group and OHI+ Delayed Therapy (DT) group, on HbA1c, FBG, FPI levels and Insulin Resistance calculated through Homeostasis Model Assessment (HOMA-IR) to fill the research gap. A parallel group, single blind three-arm design randomized controlled trial (RCT) will be conducted over a period of approximately 2 years. More than 1000 patients will be screened for CP with T2DM to recruit 150 participants for the study. They will be randomly allocated in each group (with 50 in each group). Post-therapy follow-up will be for 1, 3 and 6 months to evaluate short term and long term changes in status of CP, FBG, FPI and HbA1c respectively. Structured screening form will be used to collect baseline information. HbA1c, FBG levels and IL will be recorded at standardized lab, whereas, CP will be evaluated using standardized periodontal indices by calibrated examiners. Stata version 11.0 will be used for all kind of data management. Descriptive analysis will be performed using frequency percentages of the categorical variables whereas, mean (standard deviation) will be calculated for all continuous study variables. Inferential statistics will include Chi-square test to assess proportional differences of the categorical variables between the three interventional groups. Whereas, one-way Analysis of Variance test (ANOVA) will be used to evaluate the mean differences of the continuous variables in three different groups. McNemar's Chi-square and Repeated Measure Analysis of Variance (RMANOVA) will be used to assess differences in categorical and continuous variables respectively over time for each intervention group; and particularly to assess second secondary study objective. For insulin resistance HOMA-IR will be calculated to assess an association between CP and insulin resistance.
Investigators
Ambrina Qureshi
Prof. Dr.
Dow University of Health Sciences
Eligibility Criteria
Inclusion Criteria
- •Age between 35 to 65 years patients suffering from moderate to severe CP at baseline and having HbA1c level ≥7% and \<10% at baseline with already diagnosed T2DM at least an year ago will be included as study sample. Moreover, those currently under oral glycemic therapy, having at least 16 natural teeth for the entire study duration and not under any definitive periodontal treatment since last 6 months of baseline visit will be considered as inclusion criteria along with no oral soft tissue lesions and those willing to sign informed consent will be considered to be recruited for this trial
Exclusion Criteria
- •Pregnant or breast feeding women
- •Gestational Diabetes
- •Patients currently receiving dialysis
- •Patients with cardiac pacemakers
- •Alcoholic
- •Patients with any serious concurrent disease or complication with \<1 year of life expectancy.
- •Patients suffering from myelo-proliferating disorder (such as sickle cell disease) or under any such treatment that promotes a shift in the hemoglobin pattern.
- •Under any anti-inflammatory drugs (daily for \>7 consecutive days) within last 2 months of baseline visit, other than low dose aspirin prescribed for Cardio-vascular disease
- •Under any systemic immunosuppressive drugs like corticosteroids, cyclosporine etc.
- •Under any systemic antibiotics for \>7 consecutive days within last four weeks of baseline visit.
Arms & Interventions
Test Group 1
The participants in this group will receive a combination of ultrasonic scaling and hand instrumentation required for planing of the root surfaces (SRP) followed by systemic AAT followed by routine warm salt water rinses for 3-5 days and OHI. SRP will be performed using ultrasonic scaling device at medium intensity. In addition to ultrasonic scalar, hand instrumentation (using sharpened and sterilized curettes) may also be used if required to smoothen certain irregular areas of root surface until the surfaces are smooth. Systemic AAT would contain Metronidazole (MET) 400 mg x 3 for 10 days. OHI would include brushing teeth using soft bristles toothbrush and fluoridated toothpaste twice daily (morning after breakfast and night before sleeping) using Modified Bass Technique.
Intervention: Metronidazole
Test Group 1
The participants in this group will receive a combination of ultrasonic scaling and hand instrumentation required for planing of the root surfaces (SRP) followed by systemic AAT followed by routine warm salt water rinses for 3-5 days and OHI. SRP will be performed using ultrasonic scaling device at medium intensity. In addition to ultrasonic scalar, hand instrumentation (using sharpened and sterilized curettes) may also be used if required to smoothen certain irregular areas of root surface until the surfaces are smooth. Systemic AAT would contain Metronidazole (MET) 400 mg x 3 for 10 days. OHI would include brushing teeth using soft bristles toothbrush and fluoridated toothpaste twice daily (morning after breakfast and night before sleeping) using Modified Bass Technique.
Intervention: Scaling Root Planing
Test Group 1
The participants in this group will receive a combination of ultrasonic scaling and hand instrumentation required for planing of the root surfaces (SRP) followed by systemic AAT followed by routine warm salt water rinses for 3-5 days and OHI. SRP will be performed using ultrasonic scaling device at medium intensity. In addition to ultrasonic scalar, hand instrumentation (using sharpened and sterilized curettes) may also be used if required to smoothen certain irregular areas of root surface until the surfaces are smooth. Systemic AAT would contain Metronidazole (MET) 400 mg x 3 for 10 days. OHI would include brushing teeth using soft bristles toothbrush and fluoridated toothpaste twice daily (morning after breakfast and night before sleeping) using Modified Bass Technique.
Intervention: Oral Hygiene Instructions
Test Group 2
The participants in this group will receive a combination of Scaling Root Planing followed by routine warm salt water rinses for 3-5 days and OHI. Same procedure for SRP and OHI will be followed as that followed in Test Group 1
Intervention: Scaling Root Planing
Test Group 2
The participants in this group will receive a combination of Scaling Root Planing followed by routine warm salt water rinses for 3-5 days and OHI. Same procedure for SRP and OHI will be followed as that followed in Test Group 1
Intervention: Oral Hygiene Instructions
Control Group 3
The participants in this group will receive only routine warm salt water rinses for 3-5 days and Oral Hygiene Instructions as that followed in Test Group 1 and Test Group 2. However, after completing six (6) months of evaluation they will be provided DT either in the form of SRP+MET or SRP only in addition to OHI, whichever would be found to have a significant beneficial effect on CP.
Intervention: Oral Hygiene Instructions
Outcomes
Primary Outcomes
Glycated Hemoglobin (HbA1c)
Time Frame: Change from baseline (0) to 3 months and 6 months post intervention
To examine effects of three non-surgical periodontal therapies through change in HbA1c levels
Secondary Outcomes
- Fasting Plasma Insulin (FPI) levels(at 3 and 6 month follow-up between groups.)
- Clinical Periodontal Measure 3(Change at 1 and 3 months post intervention in all three groups)
- Fasting Blood Glucose (FBG)(at 3 and 6 month follow-up between groups.)
- Clinical Periodontal Measure 1(Change at 1 and 3 months post intervention in all three groups)
- Clinical Periodontal Measure 2(Change at 1 and 3 months post intervention in all three groups)
- HOMA-IR(at 3 and 6 month follow-up between groups.)