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Effects of Periodontal Treatment on Diabetes and Chronic Kidney Disease


Introduction: Periodontitis affects 47.2% of the US population and 64% of adults over 65 (20). Chronic kidney disease (CKD) affects an estimated 13% to 16% of the US population and accounts for 27% of Medicare spending in 2007 (1). The central question (PICO) in this study is: In a population of patients with compromised renal function, is there a difference in reduction of systemic markers of HBA1C and serum albumin between the intensive periodontal intervention and community treatment group?

Materials and Methods: This is an ongoing unblinded, randomized, controlled pilot trial with two intent-to-treat treatment arms: immediate intensive periodontal therapy or delayed intensive periodontal therapy. The goal of this study was to test the feasibility of conducting this trial among an underserved population (mostly poor and/or low literacy), and to determine the variability of HbA1c levels and albumin/creatinine ratio (A/C%) in response to intensive periodontal therapy over a 4-month period among participants with both CKD and significant periodontal disease. Smoking habits were also reported in a survey taken at baseline.

Results: In the treatment group, HbA1c at baseline (6.35%) did not show any difference at 4 months (6.4%) with a change of 0.05. In the control group, HbA1c was virtually the same at baseline (6.68%) and 4 months (6.5%) with a change of -.018. The A/C % ratio for the treatment group at baseline (674.80 mg/g) and at 4 months (639.68 mg/g) showed a change of 167.47. In the control group, the A/C % ratio at baseline (629.40 mg/g) and at 4 months (302.75 mg/g) showed a change of -232.97. Although the changes in A/C % ratio seemed dramatic, their p-values were 0.5625 and 1.000, respectively, indicating no statistical difference. Correlation for smokers could not be performed due to low sample size of 5 subjects in treatment and 2 in control groups.

Conclusion: Given the small sample size, this study showed no statistically significant reduction in systemic markers of diabetes as represented by HbA1c or chronic renal disease as represented by albumin/creatinine % ratio. Since this is an ongoing study, when it reaches 51 subjects, there may be a statistically significant improvement in systemic markers of HbA1c and albumin/creatinine % levels. Finally, when all the analysis of the blood samples taken are completed on 51 subjects at 12 months, there will be much more information that can be used to answer the research question.

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