The Effect of Diabetes on Outcomes of Non-Surgical Periodontal Therapy: A Systematic Review With a Meta-Analysis and Trial Sequential Analysis

Objective: The aim of this systematic review was to critically assess and synthesise the current scientific evidence of the potential impact of diabetes mellitus (DM) on treatment outcomes in periodontitis patients following NSPT, incorporating recent advancements in meta-analytical techniques.

Methods: To identify eligible studies meeting this aim, a comprehensive search was conducted in MEDLINE-PubMed and Cochrane-CENTRAL from their inception until April 2024. The inclusion criterion for suitable studies was the availability of data for a group of patients with solely periodontitis and a group with both DM and periodontitis. Study parameters needed to include probing pocket depth (PPD) and clinical attachment level (CAL) as the primary outcomes of interest. As secondary study parameters, gingival indices, plaque indices, and gingival recession were considered. Data from all included studies were presented descriptively, and a meta-analysis was conducted when quantitative methods were feasible.

Results: Screening of the 3574 papers resulted in 32 eligible publications, which reported 30 unique studies. Meta-analyses showed no differences of means in incremental changes from baseline to post-NSPT between the DM and non-diabetics (NDM) groups for CAL and PPD. Moreover, the secondary outcomes also revealed no significant differences regarding the response to therapy. Based on the Trial Sequential Analysis (TSA) of these meta-analyses, the effect was found to be conclusive and reliable, indicating that additional data are unlikely to alter the summary effect.

Conclusion: Based on the evidence profile, it can be stated with moderate certainty that the difference in treatment outcomes of periodontitis patients following NSPT between the DM and NDM groups is insignificant.