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Effect of Periodontal Treatment on the Improvement of Type 2 Diabetes Mellitus Outcomes
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
To assess the efficiency of periodontal treatment (PT) in improving diabetes-related outcomes in adults with type 2 diabetes mellitus (T2DM) and periodontitis, providing an updated and comprehensive synthesis from economic evaluations (EE).
METHODS
Seven databases and one register were independently searched by two reviewers for articles published up to 8 May 2024. Studies that assessed the efficiency of PT versus no treatment or other dental treatments were included. Risk of bias was assessed using the Cochrane RoB 2, ROBINS-I and ECOBIAS tools for the first stage of EE and the CHEERS checklist and NICE quality appraisal tool for overall EE. Qualitative and quantitative syntheses of the articles were conducted and assessed using the GRADE approach.
RESULTS
Eleven studies were included. PT reduces total healthcare costs, including inpatient and outpatient, diabetes-related costs and other drug costs (low to moderate certainty). A total incremental net benefit of USD 12 348 (2022 currency, 95% CI 12 195-12 500) was estimated from three high-quality model-based cost-utility analyses (high certainty).
DISCUSSION
The inclusion of PT in the comprehensive treatment of patients with T2DM and periodontitis is cost-effective. Future research is required to ensure the transferability of these findings and inform decision makers from different countries.
Additional Info
Efficiency of periodontal treatment to improve type 2 diabetes mellitus outcomes: A systematic review and meta-analysis of economic evaluations
Community Dent Oral Epidemiol 2024 Aug 16;[EPub Ahead of Print], G Sáenz-Ravello, M Castillo-Riquelme, C Cuadrado, J Gamonal, M BaezaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Type 2 diabetes mellitus and periodontitis are both chronic, noncommunicable diseases that, when they occur in the same patient, often exacerbate each other. Effective treatment of periodontitis has been shown to not only improve oral health but also reduce the severity of diabetes, as measured by lowered HbA1c and C-reactive protein (CRP) levels. However, despite this added benefit of periodontal treatment, few systems provide oral health benefits in managing type 2 diabetes mellitus. The authors postulate that the evidence of substantial cost-savings from treating periodontitis in patients with diabetes may influence decision-makers to provide periodontal coverage as part of diabetes management.
The authors conducted a meta-analysis of studies assessing the impact of periodontal treatment in patients with type 2 diabetes mellitus and periodontitis from an economic perspective. To do this, they searched seven databases and one register following the Cochrane Collaboration guidelines and used appropriate tools to assess the risk of bias. The reviewed studies included only those conducted on adults older than 18 years and those that compared outcomes, including mortality, costs, total net benefit, quality-adjusted life years, incremental cost-effectiveness ratios, and measures of diabetes outcomes (HbA1c and CRP) between patients who received periodontal interventions and those who received only routine prophylaxis or no periodontal treatment.
A total of 770 articles were initially screened, of these 11 were ultimately included in the analyses. These articles included seven cost-benefit analyses, three cost-utility analyses, and one cost-effectiveness analysis conducted in seven different countries, including five studies from the US. The results showed that providing periodontal treatment as part of diabetes management improved the outcomes and reduced the total per-capita healthcare expenditures and diabetes-related costs by 4% to 6%. Meta-analyses of high-quality cost-utility studies found that the total incremental net benefit of periodontal therapy was 12,348 USD, meaning that providing periodontal care to patients with type 2 diabetes mellitus would result in cost savings over the expected lifetime of the patient. The authors concluded that including periodontal treatment in the management of type 2 diabetes mellitus not only improves metabolic control but is also cost-effective and can generate cost savings for healthcare systems.