Treating gum disease could help people with type 2 diabetes manage their blood glucose levels and may reduce their risk of diabetes-related complications, study funded by Diabetes UK has found.

Intensive treatment for periodontitis improved blood glucose control in people with the condition and was linked to improvements in kidney and blood vessel function.

Researchers at the UCL Eastman Dental Institute recruited 264 people with type 2 diabetes, all with moderate to severe periodontitis. Half of the participants received intensive treatment for their gum disease, which involved deep cleaning their gums and minor gum surgery. The other half received standard care, involving regular cleaning and polishing of their teeth. The treatments were provided alongside any type 2 diabetes medications being taken.

Currently people with type 2 diabetes aren’t given oral health advice or treatment as part of their routine diabetes care. Dr Elizabeth Robertson, Director of Research at Diabetes UK

After 12 months, participants receiving the intensive treatment had reduced their blood glucose levels (HbA1c) by on average 0.6% more than the standard care group. This suggests that intensive gum disease treatment could help some people with type 2 diabetes to improve their blood glucose levels.

Gum disease affects almost half of the UK population and people with diabetes have a higher risk of developing it. Gum disease sets in when the levels of bacteria inside the mouth are out of balance, and it causes chronic inflammation inside the body. This inflammation has been linked to cardiovascular and kidney complications, as well as insulin resistance.

The findings, published in The Lancet Diabetes and Endocrinology, are the first to link intensive gum disease treatment to improvements in kidney and blood vessel function and chronic inflammation. While more research is needed to explore this connection, the findings suggest that treatment may help to reduce the risk of serious diabetes-related complications, such as heart disease, stroke and kidney disease, in people with type 2 diabetes.

The researchers also observed a link between the treatment and improved quality of life.

‘New and important way’ to help people with type 2 diabetes

Professor Francesco D’Aiuto, lead researcher of the study, said: “Our findings suggest preventing and treating gum disease could potentially be a new and important way to help people with type 2 diabetes manage their condition, and reduce their risk of its serious complications.

“The improvement in blood glucose control we observed, in people who received intensive treatment, is similar to the effect that’s seen when people with type 2 diabetes are prescribed a second blood glucose lowering drug. We now need to determine if the improvements we found can be maintained in the longer-term and if they apply to everyone with type 2 diabetes.”

Professor John Deanfield, senior investigator of the study at the UCL Institute of Cardiovascular Sciences, said: “Inflammation may be part of the biological pathways that lead to several health conditions including diabetes, heart disease, dementia and cancer.

“Our findings that reduction in periodontitis, which is a common cause of inflammation, improves vascular, renal, as well as blood glucose control, in people with type 2 diabetes, are exciting and could lead to new strategies to improve care. Large-scale clinical outcome trials should now be designed.”

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said: “Currently people with type 2 diabetes aren’t given oral health advice or treatment as part of their routine diabetes care. While more work is needed to fully understand how good oral health could help with blood glucose management, this research gives us important insights into the potential benefits of looking after your oral health if you have type 2 diabetes.”

Diabetes UK is the largest funder of diabetes research in the UK, investing around £7 million every year.

The project was also part-funded by the National Institute for Health Research (NIHR), via the UCLH Biomedical Research Centre, as part of a comprehensive new research programme in the field of Oral Health.

Working towards a dental care Commissioning Standard

Alongside this research, Diabetes UK has been working closely with the Office of the Chief Dental Officer, England and others to develop a Commissioning Standard for dental care for people with or at risk of type 2 diabetes.

Once developed, this standard will support the development of clinical care pathways that aim to improve both general and oral health outcomes, by ensuring that patients with diabetes who go to see their GP are also referred to their dentist. This will mirror existing pathways for foot care, where people with diabetes are referred to a podiatrist to have problems with their feet seen to by a specialist.

In May last year, the DT reported on the results of a national survey which highlighted a lack of education in gum disease relating to diabetes.

The British Society of Periodontology (BSP) and Diabetes.co.uk teamed up to publish the report into oral health, as part of an annual drive to raise awareness of gum disease among health professionals and the public.