The effect of antimicrobial periodontal treatment on circulating tumor necrosis factor-alpha and glycated hemoglobin level in patients with type 2 diabetes

Background: Tumor necrosis factor-alpha (TNF-alpha) may play an important r ole in insulin resistance. In this study, we hypothesized that TNF-alpha pr oduced due to periodontal inflammation synergistically affects insulin resi stance as well as TNF-alpha produced from adipose tissues in insulin-resist ant type 2 diabetes patients. Therefore, to understand the effects of antim icrobial periodontal therapy on serum TNF-alpha concentration and subsequen t metabolic control of diabetes, we examined the periodontal and diabetic s tatus on 13 type-2 diabetes patients. Methods: These patients were treated with local minocycline administration in every periodontal pocket around all existing teeth once a week for a mon th. Before and after treatment, the number of total bacteria in the periodo ntal pockets and circulating TNF-alpha concentration were measured and the HbA1c value was assessed. Results: Antimicrobial therapy significantly reduced the number of microorg anisms in periodontal pockets (P <0.01). After treatment, the circulating T NF-alpha level was significantly reduced (P <0.015). The HbA1c value was al so reduced significantly (P <0.007). In addition, the 6 patients who were n ot receiving insulin therapy demonstrated decreased fasting insulin levels (P <0.03), and HOMA-R (P <0.03) indices. The average reductions in circulat ing TNF-alpha concentration and HbA1c value were 0.49 pg/ml and 0.8%, respe ctively. Conclusion: The results indicate that anti-infectious treatment is effectiv e in improving metabolic control in diabetics, possibly through reduced ser um TNF-alpha and improved insulin resistance.