Clinical and microbiologic responses to periodontal therapy depend on the patient’s diabetic status. Well-controlled diabetic patients respond to therapy similar to non-diabetic patients.84-87 In patients with moderate and poorly controlled diabetes, varying results have been reported. Some studies report achieving a mild reduction in glycemic index after periodontal therapy, while the largest randomized controlled study performed to date shows no change in HbA1c in response to periodontal therapy.81 The best evidence to date shows that if an effect occurs, it does not last beyond 3-4 months after therapy without further interventions. However, the variability in this response to therapy may relate to some of the comorbities of diabetes, including obesity and cardiovascular disease, which may alter response to therapy.83,89 There is cross-sectional data to suggest that periodontal treatment is associated with a reduction in HbA1c and decreased overall medical expenses in a large cohort (> 5000 patients) of individuals.90 The mechanism of this interaction, however, remains unclear and may simply indicate that those patients who sought dental treatment were overall more committed to healthy lifestyle changes that improved their overall health and glycemic control.
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