Jean Claude Katte

Effects of nonsurgical periodontal treatment on glycated haemoglobin on type 2 diabetes patients (PARODIA 1 study): a randomized controlled trial in a sub-Saharan Africa population

BackgroundThere is a burglar association between diabetes and periodontitis. Many studies has shown that periodontitis treatment can help improving glycemic control in diabetes patients but little evidence of non-surgical treatment benefit is available in sub Saharan african diabetes patients. We aimed to assess the effects of non-surgical periodontal treatment (NSPT) of chronic periodontitis on glycaemic control in poorly controlled type 2 diabetes patients (T2D) in a sub-Saharan Africa urban setting.MethodsA total of 34 poorly controlled T2D patients with chronic periodontitis aged 51.4u2009±u20098.8xa0years (meanu2009±u2009SD), with known duration of diabetes of 55.5u2009±u200942.6xa0months, and HbA1c of 9.3u2009±u20091.3% were randomly assigned to two groups. The treatment group (Group 1, nu2009=u200917) received immediate ultrasonic scaling, scaling and root planning along with subgingival 10% povidone iodine irrigation, whereas the control group (Group 2, nu2009=u200917) was assigned to receive delayed periodontal treatment 3xa0months later. Pharmacological treatment was unchanged and all participants received the same standardized education session on diabetes management and dental hygiene. The primary outcome was the 3-month change in HbA1c from baseline. Plaque index (PI), gingival bleeding index (GBI), pocket depth (PD), clinical attachment loss (CAL) were also assessed prior to, at 6 and 12xa0weeks after enrolment.ResultsTwo subjects in each group were excluded from the study. Data were analyzed on thirty patients (15 per group). Non-surgical periodontal treatment with education for better dental hygiene (group 1) significantly improved all periodontal parameters whereas education only (group 2) improved only the plaque index among all periodontal parameters. Immediate non-surgical periodontal treatment induced a reduction of HbA1c levels by 3.0u2009±u20092.4 points from 9.7u2009±u20091.6% at baseline to 6.7u2009±u20092.0% 3xa0months after NSPT, (p ˂ 0.001) but the change was not significant in group 2, from mean 8.9u2009±u20090.9% at baseline vs 8.1u2009±u20092.6% after 3xa0months (pu2009=u20090.24).ConclusionNon-surgical periodontal treatment markedly improved glycaemic control with an attributable reduction of 2.2 points of HbA1c in poorly controlled T2D patients in a sub Saharan setting.Trial registrationClinicalTrials.gov Identifier: NCT02745015 Date of registration: July 17, 2016 ‘Retrospectively registered’.

P1089 Effets à court terme de l’insulinothérapie intensive sur la sensibilité à l’insuline au cours des décompensations hyperglycémiques du diabète de type 2

Introduction L’insulinotherapie intensive sur 4 semaines ameliore la secretion et la sensibilite a l’insuline, cependant la duree habituelle d’hospitalisation lors des decompensations du diabete de type 2 excede rarement une semaine. Notre etude avait pour objectif d’evaluer les effets a court terme de l’insulinotherapie intensive au cours des decompensations hyperglycemiques du diabete de type 2. Patients et methodes Nous avons explore 15 patients admis pour decompensation hyperglycemique d’un diabete de type 2 (glycemie capillaire > 3xa0g/L et HbA1c > 8 %) ayant un IMC de 26,4xa0±xa03,9xa0kg/m 2 ) au Service d’Endocrinologie de l’Hopital Central de Yaounde. Les patients ont tous ete traites par un schema d’insulinotherapie intensive au pousse seringue electrique pendant 24 heures suivi d’un protocole sous cutane intensif du 2 e au 7 e jour avec titration pour le maintien de la glycemie capillaire entre 0,70 et 1,40xa0g/L. La sensibilite a l’insuline a ete mesuree a l’aide du test court de tolerance a l’insuline a J2 et J8, avec calcul de la constante de decroissance glycemique KITT. Le protocole a ete approuve par le comite national d’ethique et tous les sujets sont donne leur consentement ecrit. Resultats La glycemie a jeun a varie de 385,4xa0±xa098,6 a l’admission a 134,4xa0±xa018,2xa0mg/dL a J7 (P Conclusion Une semaine d’insulinotherapie intensive ameliore significativement l’equilibre glycemique et la sensibilite a l’insuline au cours des decompensations hyperglycemiques du diabete de type 2 et pourrait constituer une justification supplementaire du relais precoce par traitement oral.