Treatment Regimen for Gum Disease in Diabetics Improves Glucose Status Along with Oral Health, UB Study Shows

BUFFALO, N.Y. -- Diabetics with gum disease who were treated for 12 weeks with a medication aimed at stabilizing collagen and improving their immune response completed the three-month trial with better blood-sugar levels, as well as significantly improved oral health, a study conducted by dental researchers at the University at Buffalo has shown.

Results of this double-blind, case-control study showed that participants who received 20 mg. of a submicrobial dose of doxycycline (Periostat) twice a day had better outcomes on several measures of periodontal disease and showed lower levels of glucose and certain markers of inflammation in blood samples.

Results of the study were presented today (March 15, 2003) at the American Association of Dental Research meeting in San Antonio.

"Gum disease is a major complication of diabetes, registering fourth in importance after heart disease, stroke and blindness," said study co-author Sebastian Ciancio, D.D.S., SUNY Distinguished Service Professor and chair of the Department of Periodontics and Endodontics in the UB School of Dental Medicine.

"Persons with uncontrolled or poorly controlled diabetes can lose all their teeth due to severe gum disease," Ciancio said. "Our study and others being presented at this meeting reporting the same favorable outcome for both gum disease and glycemic control with a sub-antibacterial dose of an antibiotic are very promising and very exciting."

Approximately 17 million people in the U.S., or 6 percent of the population, have diabetes, according to the American Diabetes Association. While the biological link between diabetes and gum disease is not clear, Ciancio said, poor blood-sugar control is known to increase gum problems.

The UB dental researchers, working with the Diabetes-Endocrinology Center of Western New York, affiliated with UB and Kaleida Health, designed a clinical trial to compare the success of using the drug Periostat (which contains doxycycline, but has no bacteria-killing potential) and standard dental treatment for periodontal disease, with standard dental treatment plus a placebo instead of the active drug.

Twenty adult diabetics with periodontal disease were assigned randomly to either a test group or control group. Their oral health was assessed and blood samples were drawn when the study began and at six and 12 weeks thereafter. Blood samples were assessed for levels of glucose and several proinflammatory enzymes at the three time periods.

Periodontal status and blood markers improved in both groups, but the improvements reached statistical significance only in the test group. Results showed that:

* HBA1c levels (a measure of blood glucose) decreased by 1 unit in the test group, but did not change in controls.

* The proinflammatory enzyme MMP-9 decreased by approximately 100 units in the test group and only 12 units in controls

* ROS (reactive oxygen species, also an inflammatory marker) generation decreased by 25 units in the test group and increased by 15 units in controls.

* Probing pocket depth improved by 1.7 mm more and clinical attachment levels by 1.6 mm more in the test group than the controls

"The results of this study suggest that patients with diabetes may benefit from a combination of periodontal therapy and administration of Periostat, not only to improve clinical parameters, but also to improve control of blood glucose," Ciancio said.

Additional researchers on the study were M.N. Al-Ghazi, Ph.D., of King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia; Ahmad Aljada, Ph.D., UB research assistant professor of medicine; Michelle Bessinger, research assistant, and Maryanne Mather, research associate, both from the UB dental school; and Priya Mohanty, M.D., and Paresh Dandona, M.D., of the Diabetes-Endocrinology Center of Western New York.

The research was supported in part by a grant from CollaGenex Pharmaceuticals, Inc., maker of Periostat.