Journal of Education and Health Promotion

Abstract OBJECTIVES: This study aimed to evaluate the role of nonsurgical periodontal therapy in improving
glycemic control among type 2 diabetes mellitus (T2DM) patients.
MATERIALS AND METHODS: Adult T2DM patients with mild‑to‑moderate periodontal disease,
reporting to a tertiary care diabetes center in South India, from January to June 2014, were enrolled
in the study. Medical management of T2DM along with diet and physical exercise was an inclusion
criterion. Patients with factors affecting periodontal health and an inability to follow‑up were excluded
from the study. All patients underwent nonsurgical periodontal therapy (scaling, root planing, and
irrigation of chlorhexidine [0.12%]). Periodontal status and glycated hemoglobin A1c (HbA1c) were
assessed preoperatively and 6 months posttreatment. Dental status, diabetic history, and demographic
characteristics were recorded to evaluate confounding roles.
RESULTS: A total of 266 T2DM patients (91 females/175 males; mean age
47.65  ±  5.93  years/range 25–55  years), fulfilling the inclusion criteria, were enrolled. The mean
pre‑ and post‑treatment HbA1c levels were respectively, 8.44 ± 1.87 and 7.98 ± 1.81, with a mean
reduction of 0.46 ± 0.26 (P < 0.001). Significant HbA1c reduction (P < 0.001) was observed in patients
with good pretreatment glycemic control (0.54 ± 0.26; 7.9%), regular follow‑up (0.51 ± 0.28; 6.2%),
and good oral hygiene (0.60 ± 0.49; 8.0%).
CONCLUSION: Nonsurgical periodontal therapy is associated with significant HbA1c reduction
among T2DM patients with mild‑to‑moderate periodontitis after a 6‑month follow‑up period.

Abstract BACKGROUND: The purpose of this study was to evaluate diabetes control, as measured by
hemoglobin A1c (HbA1c) improvements among African American and Hispanic patients receiving
conventional clinical treatment combined with a bilingual diabetes educator using culturally and
linguistically appropriate educational materials. This study also sought to estimate the healthcare cost
savings resulting from any A1c improvements and assess the cost‑effectiveness of this approach.
MATERIALS AND METHODS: This was a multistage, face‑to‑face observational study undertaken
in Texas, United States and focused on 153 African American and Hispanic patients with poor
blood glucose control (baseline A1c >8.0%). For two years, a bilingual care coordinator motivated
patient behavior changes that could lead to improvements in glucose control. The primary
evaluation measure was change in %HbA1c, with secondary measures being change in blood
pressure (BP) and low‑density lipoprotein (LDL). We also sought to gauge the program’s potential
cost‑effectiveness.
RESULTS: Within the study group, A1c levels decreased over the study period from a mean of
10.0% to 8.4%. The same group saw no statistically significant improvement (reduction) in blood
concentrations of LDL. The African American subgroup had a small reduction in systolic BP while
changes for non‑White Hispanics were not statistically significant. The average A1c reduction
realized in this observational study provided estimated cost savings that are nearly twice pilot
expenditures.
CONCLUSIONS: Combining standard diabetes care with a bilingual educational care coordinator
results in significant reductions in mean A1c (−1.6% HbA1c) in patients with poorly controlled blood
glucose and African American/non‑White Hispanic heritage, an intervention that also was shown to
be cost‑effective. This may be an effective model for improving diabetes care in provider practices.