Downloaded from jada.ada.org on December 14, 2014
Diabetes and periodontal therapy Bruce L. Pihlstrom and John B. Buse JADA 2014;145(12):1208-1210 10.14219/jada.2014.112 The following resources related to this article are available online at jada.ada.org (this information is current as of December 14, 2014): Updated information and services including high-resolution figures, can be found in the online version of this article at: http://jada.ada.org/content/145/12/1208
This article cites 14 articles, 2 of which can be accessed free: http://jada.ada.org/content/145/12/1208/#BIBL Information about obtaining reprints of this article or about permission to reproduce this article in whole or in part can be found at: http://www.ada.org/990.aspx
Copyright © 2014 American Dental Association. All rights reserved. Reproduction or republication strictly prohibited without prior written permission of the American Dental Association.
Downloaded from jada.ada.org on December 14, 2014
Commentaries
guest Editorial
Diabetes and periodontal therapy
Bruce L. Pihlstrom, DDS, MS; John B. Buse, MD, PhD
T
his issue of The Journal of the American Dental Association (JADA) contains a report1 of the periodontal treatment response among people who participated in the Diabetes and Periodontal Therapy Trial (DPTT).2 The DPTT is a large, multicenter randomized controlled clinical trial that was designed to study the effect of nonsurgical periodontal therapy among people who have type 2 diabetes mellitus and periodontitis. The periodontal treatment consisted of two or more sessions of scaling and root planing (totaling more than 2.5 hours and involving the use of local anesthetic) and follow-up supportive periodontal care. The main conclusion of this six-month trial was that nonsurgical periodontal therapy did not improve glycemic control in patients with type 2 diabetes who had periodontitis.2 This trial has received considerable attention because its findings are contrary to what many people anticipated—and because it did not support results of smaller clinical trials and meta-analyses that showed improvements in hemoglobin A1c (HbA1c) levels as a result of nonsurgical periodontal therapy.3 We wish to address the generalizability of the DPTT. As reported by the authors in this issue of JADA,1 the patient sample of the DPTT reflects the population of people with diabetes in the United States. The DPTT included participants who had type 2 diabetes with HbA1c levels between 7 percent and less than 9 percent; 72 percent of the participants were obese (body mass index [BMI] greater than 30 kilograms per square meter).1 The National Health and Nutrition Examination Survey is a population-based survey of people with diabetes in the United States; its results demonstrated that only 12.6 percent of people with diabetes in the United States are estimated to have HbA1c levels greater than 9 percent and 62.4 percent to have a BMI of 30 or greater.4,5 The DPTT does not address the possible effect of periodontal treatment in the 12 percent of the population with HbA1c levels greater than 9 percent or the 50 percent of the population with HbA1c levels less than 7 percent, because efforts were made to exclude these patients. However, the magnitude of obesity was not constrained by trial entry criteria. Patients with type 2 diabetes who have HbA1c levels higher than 9 percent and a BMI of less than 30 are rare. Because the participant sample was typical of patients with diabetes both in terms of HbA1c and obesity, the results of the DPTT should be viewed as fully generalizable to patients with diabetes in the United States.
1208 JADA 145(12) http://jada.ada.org December 2014
Downloaded from jada.ada.org on December 14, 2014
Commentaries
In the article by Michalowicz and colleagues1 in this issue of JADA, the magnitude of periodontal treatment response in the DPTT is reported and compared with that in other studies. Data from recent large clinical trials of periodontal therapy6,7 have shown that there are variations in the effect of periodontal therapy on measures of periodontal disease among various trial sites, and that the treatment effect may be less than the treatment response reported in small-scale, single-center trials. It is likely that periodontal treatment effects reported in large, multicenter trials provide a realistic and generalizable estimate of the magnitude of treatment response that is achieved in the everyday practice of dentistry. A major advantage of large multi-
would reduce cardiovascular events.8 The Normoglycemia in Intensive Care Evaluation–Survival Using Glucose Algorithm Regulation (NICE-SUGAR) study was a multicenter trial9 designed to examine the benefit of rigorous management of blood sugar levels in an intensive care unit, the results of which had been demonstrated previously in a single-center study. The results of both studies demonstrated no benefit, but rather harm in the form of excess mortality. The results of both trials were embraced by the community of general medical practitioners because, frankly, they made both patients’ and practitioners’ lives easier because they did not have to worry about another expensive and burdensome treatment. However,
for emphasis). Concerns that have been expressed about the DPTT include the following: dan effect of periodontal treatment on glycemic control would not be expected as a result of periodontal therapy because the participants’ baseline HbA1c levels already were close to those reflecting good glycemic control3,11; dthe periodontal treatment was inadequate3,11; dpronounced obesity would mask any decreased inflammatory response caused by successful periodontal treatment3,12; dantimicrobial agents and other treatment strategies were not used as part of the periodontal therapy.13 These concerns were addressed by the DPTT investigators in The
No clinical trial can answer all questions about a given treatment or disease—and the Diabetes and Periodontal Therapy Trial is no exception. However, it provides important information about the lack of effectiveness of nonsurgical periodontal treatment in reducing hyperglycemia in most patients with type 2 diabetes. center trials is that their findings are more generalizable to the real world of patient care than are those of small trials that often are conducted by specialists in highly selected patient samples. In diabetes, it is not uncommon that the conventional wisdom based on epidemiologic findings or on results of single-center studies does not hold up in multicenter trials. Epidemiology is useful for generating hypotheses regarding the effects of particular treatments, but the effects as compared with no treatment or an alternative treatment can be measured only in a trial. Singlecenter studies often are not generalizable because of the particulars of the technique or the dynamics of the team or because the characteristics of the patients cannot be generalized. The investigators in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial examined the epidemiologic hypothesis that aiming for normal levels of glucose
the same results were vilified by subspecialists who insisted that the intervention could be performed more skillfully or that there are subpopulations who would benefit from it. Subsequent guidelines10 continue to support the unpopular conclusions of the ACCORD and NICE-SUGAR studies. For now, it is well accepted that these approaches to diabetes management that were widely touted on the basis of findings from epidemiologic studies and single-center studies were not only unhelpful but also potentially harmful in the general population. DPTT has been characterized as having fundamental problems, and there has been a call by prominent periodontal researchers for “all interested parties to refrain from using these [DPTT] study results as a basis for future scientific texts, new research projects, guidelines, policies, and advice regarding the incorporation of necessary periodontal treatment in diabetes management”3 (italics added
Journal of the American Medical Association (JAMA).14 Rather than urge censorship of the DPTT’s results, we encourage interested parties to carefully read the comments about the DPTT and the investigators’ reply in JAMA and to make their own decisions about the study’s findings. Overall, it is clear to us that the DPTT was designed and conducted so that its results are generalizable and applicable to most patients with type 2 diabetes who are seen in typical dental and medical practices in the United States. No clinical trial can answer all questions about a given treatment or disease—and the DPTT is no exception. It did not answer all questions regarding the possible effectiveness of periodontal treatment on glycemic control among all patients with type 2 diabetes. However, it provides important information about the lack of effectiveness of nonsurgical periodontal treatment in reducing hyperglycemia
JADA 145(12) http://jada.ada.org December 2014 1209
Downloaded from jada.ada.org on December 14, 2014
Commentaries
in most patients with type 2 diabetes. To urge censorship of the results of a well-designed and executed clinical trial is contrary to the values of academic research and its foundation of ethical open inquiry, transparency, publication and dissemination of knowledge that must be considered by those who make health care decisions. The trial serves as a valuable resource for dentists and physicians who treat patients with type 2 diabetes and provides important information for researchers in planning future studies. When conventional wisdom in diabetes care is challenged by high-quality randomized controlled trials such as ACCORD, NICESUGAR and DPTT, it is imperative that we pay attention to the results. Although well-conducted trials with unpopular results, such as ACCORD, NICE-SUGAR and DPTT, often generate criticism, large multicenter trials that are generalizable are the standard for evidencebased care. New treatments may one day reveal opportunities for lowering patients’ HbA1c levels below 6 percent, rigorous management of patient glucose levels in intensive care units, and periodontal care for those who have periodontitis. Although the DPTT findings did not show any effect on lowering hyperglycemia in patients with type 2 diabetes, they did show that periodontal treatment was safe and effective in reducing signs of periodontal disease in these patients. Until further evidence or new treatment methods are available, nonsurgical periodontal care should be delivered to achieve the important benefit of improved oral health, and not for the purpose of improving glycemic control in the vast majority of patients with type 2 diabetes. n
doi:10.14219/jada.2014.112
Dr. Pihlstrom is professor emeritus, Department of Surgical and Developmental Sciences, School of Dentistry, University of Minnesota,
Minneapolis. He was director of the extramural division of clinical research at the National Institute of Dental and Craniofacial Research from 2002 through 2007. He is a former associate editor of Journal of Clinical Periodontology and currently is the associate editor for research of The Journal of the American Dental Association, as well as an independent oral health research consultant. Dr. Buse is the Verne S. Caviness Distinguished Professor; chief, Division of Endocrinology; director, Diabetes Care Center; and the executive associate dean for clinical research, School of Medicine, University of North Carolina, Chapel Hill. He is past president for medicine and science of the American Diabetes Association and former chair of the National Diabetes Education Program, a joint effort of the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention. He has had key roles in numerous multicenter clinical trials, including two major NIHsponsored trials: Action to Control Cardiovascular Risk in Diabetes (ACCORD), for which he served as study vice-chair, and Studies to Treat or Prevent Pediatric Type 2 Diabetes (STOPPTD2). He also is former associate editor of the American Diabetes Association journals Clinical Diabetes and Diabetes Care. Disclosures. Dr. Pihlstrom has been a coinvestigator on other research projects with one of the investigators in the Diabetes and Periodontal Therapy Trial (DPTT) (B.S. Michalowicz). Dr. Pihlstrom had no role in the DPTT or its published findings, and he has no financial interests with any investigator or institution involved with the DPTT. Dr. Buse is an investigator, consultant or both without any direct financial benefit under contracts between his employer and the following companies: Amylin Pharmaceuticals (San Diego), Andromeda (a subsidiary of Hyperion Therapeutics, Brisbane, Calif.), AstraZeneca (London), Boehringer Ingelheim (Ingelheim am Rhein, Germany), Bristol-Myers Squibb (New York City), Dance Biopharm (Brisbane, Calif.), Elcelyx Therapeutics (San Diego), Eli Lilly and Company (Indianapolis), GI Dynamics (Lexington, Mass.), GlaxoSmithKline (Middlesex, United Kingdom), Halozyme Therapeutics (San Diego), F. Hoffmann-La Roche (Basel, Switzerland), Intarcia Therapeutics (Hayward, Calif.), Johnson and Johnson (New Brunswick, N.J.), Lexicon Pharmaceuticals (The Woodlands, Texas), LipoScience (Raleigh, N.C.), Medtronic (Oak Brook, Ill.), Merck (White House Station, N.J.), Metavention (Newport Beach, Calif.), Novo Nordisk (Bagsvaerd, Denmark), Orexign Therapeutics (La Jolla, Calif.), Osiris Therapeutics (Columbia, Md.), Pfizer (New York City), PhaseBio Pharmaceuticals (Malvern, Pa.), Quest Diagnostics (Madison, N.J.), Sanofi (Bridgewater, N.J.), Santarus (San Diego), Scion NeuroStim (Raleigh, N.C.), Takeda (Osaka, Japan), ToleRx and TransTech Pharma (High Point, N.C.). He is a consultant to PhaseBio Pharmaceuticals and personally has received stock options and payments for that work.
1210 JADA 145(12) http://jada.ada.org December 2014
1. Michalowicz BS, Hyman L, Hou W, et al. Factors associated with the clinical response to nonsurgical periodontal therapy in people with type 2 diabetes mellitus. JADA 2014;145(12):1227-1239. 2. Engebretson SP, Hyman LG, Michalowicz BS, et al. The effect of nonsurgical periodontal therapy on hemoglobin A 1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial. JAMA 2013;310(23):2523-2532. 3. Borgnakke WS, Chapple IL, Genco RJ, et al. The multi-center randomized controlled trial (RCT) published by the Journal of the American Medical Association (JAMA) on the effect of periodontal therapy on glycated hemoglobin (HbA1c) has fundamental problems. J Evid Based Dent Pract 2014;14(3):127-132. 4. Ali MK, Bullard KM, Saaddine JB, Cowie CC, Imperatore G, Gregg EW. Achievement of goals in U.S. diabetes care, 1999-2010. N Engl J Med 2013;368(17):1613-1624. 5. Kramer H, Cao G, Dugas L, Luke A, Cooper R, Durazo-Arvizu R. Increasing BMI and waist circumference and prevalence of obesity among adults with type 2 diabetes: the National Health and Nutrition Examination Surveys. J Diabetes Complications 2010;24(6):368-374. 6. Michalowicz BS, Hodges JS, DiAngelis AJ, et al; OPT Study. Treatment of periodontal disease and the risk of preterm birth. N Engl J Med 2006;355(18):1885-1894. 7. Offenbacher S, Beck JD, Jared HL, et al; Maternal Oral Therapy to Reduce Obstetric Risk (MOTOR) Investigators. Effects of periodontal therapy on rate of preterm delivery: a randomized controlled trial. Obstet Gynecol 2009;114(3):551-559. 8. ACCORD Study Group; Gerstein HC, Miller ME, Genuth S, et al. Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med 2011;364(9):818-828. 9. NICE-SUGAR Study Investigators; Finfer S, Liu B, Chittock DR, et al. Hypoglycemia and risk of death in critically ill patients. N Engl J Med 2012;367(12):1108-1118. 10. American Diabetes Association. Standards of medical care in diabetes: 2014. Diabetes Care 2014;37(suppl 1):S14-S80. 11. Chapple IL, Borgnakke WS, Genco RJ. Hemoglobin A1c levels among patients with diabetes receiving nonsurgical periodontal treatment (comment). JAMA 2014;311(18): 1919-1920. 12. Merchant AT. Hemoglobin A 1c levels among patients with diabetes receiving nonsurgical periodontal treatment (comment). JAMA 2014;311(18):1919. 13. Vergnes JN. Hemoglobin A 1c levels among patients with diabetes receiving nonsurgical periodontal treatment (comment). JAMA 2014;311(18):1920-1921. 14. Engebretson SP, Hyman LG, Michalowicz BS. Hemoglobin A1c levels among patients with diabetes receiving nonsurgical periodontal treatment: reply. JAMA 2014;311(18):1921-1922.
Diabetes and periodontal therapy Bruce L. Pihlstrom and John B. Buse JADA 2014;145(12):1208-1210 10.14219/jada.2014.112 The following resources related to this article are available online at jada.ada.org (this information is current as of December 14, 2014): Updated information and services including high-resolution figures, can be found in the online version of this article at: http://jada.ada.org/content/145/12/1208
This article cites 14 articles, 2 of which can be accessed free: http://jada.ada.org/content/145/12/1208/#BIBL Information about obtaining reprints of this article or about permission to reproduce this article in whole or in part can be found at: http://www.ada.org/990.aspx
Copyright © 2014 American Dental Association. All rights reserved. Reproduction or republication strictly prohibited without prior written permission of the American Dental Association.
Downloaded from jada.ada.org on December 14, 2014
Commentaries
guest Editorial
Diabetes and periodontal therapy
Bruce L. Pihlstrom, DDS, MS; John B. Buse, MD, PhD
T
his issue of The Journal of the American Dental Association (JADA) contains a report1 of the periodontal treatment response among people who participated in the Diabetes and Periodontal Therapy Trial (DPTT).2 The DPTT is a large, multicenter randomized controlled clinical trial that was designed to study the effect of nonsurgical periodontal therapy among people who have type 2 diabetes mellitus and periodontitis. The periodontal treatment consisted of two or more sessions of scaling and root planing (totaling more than 2.5 hours and involving the use of local anesthetic) and follow-up supportive periodontal care. The main conclusion of this six-month trial was that nonsurgical periodontal therapy did not improve glycemic control in patients with type 2 diabetes who had periodontitis.2 This trial has received considerable attention because its findings are contrary to what many people anticipated—and because it did not support results of smaller clinical trials and meta-analyses that showed improvements in hemoglobin A1c (HbA1c) levels as a result of nonsurgical periodontal therapy.3 We wish to address the generalizability of the DPTT. As reported by the authors in this issue of JADA,1 the patient sample of the DPTT reflects the population of people with diabetes in the United States. The DPTT included participants who had type 2 diabetes with HbA1c levels between 7 percent and less than 9 percent; 72 percent of the participants were obese (body mass index [BMI] greater than 30 kilograms per square meter).1 The National Health and Nutrition Examination Survey is a population-based survey of people with diabetes in the United States; its results demonstrated that only 12.6 percent of people with diabetes in the United States are estimated to have HbA1c levels greater than 9 percent and 62.4 percent to have a BMI of 30 or greater.4,5 The DPTT does not address the possible effect of periodontal treatment in the 12 percent of the population with HbA1c levels greater than 9 percent or the 50 percent of the population with HbA1c levels less than 7 percent, because efforts were made to exclude these patients. However, the magnitude of obesity was not constrained by trial entry criteria. Patients with type 2 diabetes who have HbA1c levels higher than 9 percent and a BMI of less than 30 are rare. Because the participant sample was typical of patients with diabetes both in terms of HbA1c and obesity, the results of the DPTT should be viewed as fully generalizable to patients with diabetes in the United States.
1208 JADA 145(12) http://jada.ada.org December 2014
Downloaded from jada.ada.org on December 14, 2014
Commentaries
In the article by Michalowicz and colleagues1 in this issue of JADA, the magnitude of periodontal treatment response in the DPTT is reported and compared with that in other studies. Data from recent large clinical trials of periodontal therapy6,7 have shown that there are variations in the effect of periodontal therapy on measures of periodontal disease among various trial sites, and that the treatment effect may be less than the treatment response reported in small-scale, single-center trials. It is likely that periodontal treatment effects reported in large, multicenter trials provide a realistic and generalizable estimate of the magnitude of treatment response that is achieved in the everyday practice of dentistry. A major advantage of large multi-
would reduce cardiovascular events.8 The Normoglycemia in Intensive Care Evaluation–Survival Using Glucose Algorithm Regulation (NICE-SUGAR) study was a multicenter trial9 designed to examine the benefit of rigorous management of blood sugar levels in an intensive care unit, the results of which had been demonstrated previously in a single-center study. The results of both studies demonstrated no benefit, but rather harm in the form of excess mortality. The results of both trials were embraced by the community of general medical practitioners because, frankly, they made both patients’ and practitioners’ lives easier because they did not have to worry about another expensive and burdensome treatment. However,
for emphasis). Concerns that have been expressed about the DPTT include the following: dan effect of periodontal treatment on glycemic control would not be expected as a result of periodontal therapy because the participants’ baseline HbA1c levels already were close to those reflecting good glycemic control3,11; dthe periodontal treatment was inadequate3,11; dpronounced obesity would mask any decreased inflammatory response caused by successful periodontal treatment3,12; dantimicrobial agents and other treatment strategies were not used as part of the periodontal therapy.13 These concerns were addressed by the DPTT investigators in The
No clinical trial can answer all questions about a given treatment or disease—and the Diabetes and Periodontal Therapy Trial is no exception. However, it provides important information about the lack of effectiveness of nonsurgical periodontal treatment in reducing hyperglycemia in most patients with type 2 diabetes. center trials is that their findings are more generalizable to the real world of patient care than are those of small trials that often are conducted by specialists in highly selected patient samples. In diabetes, it is not uncommon that the conventional wisdom based on epidemiologic findings or on results of single-center studies does not hold up in multicenter trials. Epidemiology is useful for generating hypotheses regarding the effects of particular treatments, but the effects as compared with no treatment or an alternative treatment can be measured only in a trial. Singlecenter studies often are not generalizable because of the particulars of the technique or the dynamics of the team or because the characteristics of the patients cannot be generalized. The investigators in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial examined the epidemiologic hypothesis that aiming for normal levels of glucose
the same results were vilified by subspecialists who insisted that the intervention could be performed more skillfully or that there are subpopulations who would benefit from it. Subsequent guidelines10 continue to support the unpopular conclusions of the ACCORD and NICE-SUGAR studies. For now, it is well accepted that these approaches to diabetes management that were widely touted on the basis of findings from epidemiologic studies and single-center studies were not only unhelpful but also potentially harmful in the general population. DPTT has been characterized as having fundamental problems, and there has been a call by prominent periodontal researchers for “all interested parties to refrain from using these [DPTT] study results as a basis for future scientific texts, new research projects, guidelines, policies, and advice regarding the incorporation of necessary periodontal treatment in diabetes management”3 (italics added
Journal of the American Medical Association (JAMA).14 Rather than urge censorship of the DPTT’s results, we encourage interested parties to carefully read the comments about the DPTT and the investigators’ reply in JAMA and to make their own decisions about the study’s findings. Overall, it is clear to us that the DPTT was designed and conducted so that its results are generalizable and applicable to most patients with type 2 diabetes who are seen in typical dental and medical practices in the United States. No clinical trial can answer all questions about a given treatment or disease—and the DPTT is no exception. It did not answer all questions regarding the possible effectiveness of periodontal treatment on glycemic control among all patients with type 2 diabetes. However, it provides important information about the lack of effectiveness of nonsurgical periodontal treatment in reducing hyperglycemia
JADA 145(12) http://jada.ada.org December 2014 1209
Downloaded from jada.ada.org on December 14, 2014
Commentaries
in most patients with type 2 diabetes. To urge censorship of the results of a well-designed and executed clinical trial is contrary to the values of academic research and its foundation of ethical open inquiry, transparency, publication and dissemination of knowledge that must be considered by those who make health care decisions. The trial serves as a valuable resource for dentists and physicians who treat patients with type 2 diabetes and provides important information for researchers in planning future studies. When conventional wisdom in diabetes care is challenged by high-quality randomized controlled trials such as ACCORD, NICESUGAR and DPTT, it is imperative that we pay attention to the results. Although well-conducted trials with unpopular results, such as ACCORD, NICE-SUGAR and DPTT, often generate criticism, large multicenter trials that are generalizable are the standard for evidencebased care. New treatments may one day reveal opportunities for lowering patients’ HbA1c levels below 6 percent, rigorous management of patient glucose levels in intensive care units, and periodontal care for those who have periodontitis. Although the DPTT findings did not show any effect on lowering hyperglycemia in patients with type 2 diabetes, they did show that periodontal treatment was safe and effective in reducing signs of periodontal disease in these patients. Until further evidence or new treatment methods are available, nonsurgical periodontal care should be delivered to achieve the important benefit of improved oral health, and not for the purpose of improving glycemic control in the vast majority of patients with type 2 diabetes. n
doi:10.14219/jada.2014.112
Dr. Pihlstrom is professor emeritus, Department of Surgical and Developmental Sciences, School of Dentistry, University of Minnesota,
Minneapolis. He was director of the extramural division of clinical research at the National Institute of Dental and Craniofacial Research from 2002 through 2007. He is a former associate editor of Journal of Clinical Periodontology and currently is the associate editor for research of The Journal of the American Dental Association, as well as an independent oral health research consultant. Dr. Buse is the Verne S. Caviness Distinguished Professor; chief, Division of Endocrinology; director, Diabetes Care Center; and the executive associate dean for clinical research, School of Medicine, University of North Carolina, Chapel Hill. He is past president for medicine and science of the American Diabetes Association and former chair of the National Diabetes Education Program, a joint effort of the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention. He has had key roles in numerous multicenter clinical trials, including two major NIHsponsored trials: Action to Control Cardiovascular Risk in Diabetes (ACCORD), for which he served as study vice-chair, and Studies to Treat or Prevent Pediatric Type 2 Diabetes (STOPPTD2). He also is former associate editor of the American Diabetes Association journals Clinical Diabetes and Diabetes Care. Disclosures. Dr. Pihlstrom has been a coinvestigator on other research projects with one of the investigators in the Diabetes and Periodontal Therapy Trial (DPTT) (B.S. Michalowicz). Dr. Pihlstrom had no role in the DPTT or its published findings, and he has no financial interests with any investigator or institution involved with the DPTT. Dr. Buse is an investigator, consultant or both without any direct financial benefit under contracts between his employer and the following companies: Amylin Pharmaceuticals (San Diego), Andromeda (a subsidiary of Hyperion Therapeutics, Brisbane, Calif.), AstraZeneca (London), Boehringer Ingelheim (Ingelheim am Rhein, Germany), Bristol-Myers Squibb (New York City), Dance Biopharm (Brisbane, Calif.), Elcelyx Therapeutics (San Diego), Eli Lilly and Company (Indianapolis), GI Dynamics (Lexington, Mass.), GlaxoSmithKline (Middlesex, United Kingdom), Halozyme Therapeutics (San Diego), F. Hoffmann-La Roche (Basel, Switzerland), Intarcia Therapeutics (Hayward, Calif.), Johnson and Johnson (New Brunswick, N.J.), Lexicon Pharmaceuticals (The Woodlands, Texas), LipoScience (Raleigh, N.C.), Medtronic (Oak Brook, Ill.), Merck (White House Station, N.J.), Metavention (Newport Beach, Calif.), Novo Nordisk (Bagsvaerd, Denmark), Orexign Therapeutics (La Jolla, Calif.), Osiris Therapeutics (Columbia, Md.), Pfizer (New York City), PhaseBio Pharmaceuticals (Malvern, Pa.), Quest Diagnostics (Madison, N.J.), Sanofi (Bridgewater, N.J.), Santarus (San Diego), Scion NeuroStim (Raleigh, N.C.), Takeda (Osaka, Japan), ToleRx and TransTech Pharma (High Point, N.C.). He is a consultant to PhaseBio Pharmaceuticals and personally has received stock options and payments for that work.
1210 JADA 145(12) http://jada.ada.org December 2014
1. Michalowicz BS, Hyman L, Hou W, et al. Factors associated with the clinical response to nonsurgical periodontal therapy in people with type 2 diabetes mellitus. JADA 2014;145(12):1227-1239. 2. Engebretson SP, Hyman LG, Michalowicz BS, et al. The effect of nonsurgical periodontal therapy on hemoglobin A 1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial. JAMA 2013;310(23):2523-2532. 3. Borgnakke WS, Chapple IL, Genco RJ, et al. The multi-center randomized controlled trial (RCT) published by the Journal of the American Medical Association (JAMA) on the effect of periodontal therapy on glycated hemoglobin (HbA1c) has fundamental problems. J Evid Based Dent Pract 2014;14(3):127-132. 4. Ali MK, Bullard KM, Saaddine JB, Cowie CC, Imperatore G, Gregg EW. Achievement of goals in U.S. diabetes care, 1999-2010. N Engl J Med 2013;368(17):1613-1624. 5. Kramer H, Cao G, Dugas L, Luke A, Cooper R, Durazo-Arvizu R. Increasing BMI and waist circumference and prevalence of obesity among adults with type 2 diabetes: the National Health and Nutrition Examination Surveys. J Diabetes Complications 2010;24(6):368-374. 6. Michalowicz BS, Hodges JS, DiAngelis AJ, et al; OPT Study. Treatment of periodontal disease and the risk of preterm birth. N Engl J Med 2006;355(18):1885-1894. 7. Offenbacher S, Beck JD, Jared HL, et al; Maternal Oral Therapy to Reduce Obstetric Risk (MOTOR) Investigators. Effects of periodontal therapy on rate of preterm delivery: a randomized controlled trial. Obstet Gynecol 2009;114(3):551-559. 8. ACCORD Study Group; Gerstein HC, Miller ME, Genuth S, et al. Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med 2011;364(9):818-828. 9. NICE-SUGAR Study Investigators; Finfer S, Liu B, Chittock DR, et al. Hypoglycemia and risk of death in critically ill patients. N Engl J Med 2012;367(12):1108-1118. 10. American Diabetes Association. Standards of medical care in diabetes: 2014. Diabetes Care 2014;37(suppl 1):S14-S80. 11. Chapple IL, Borgnakke WS, Genco RJ. Hemoglobin A1c levels among patients with diabetes receiving nonsurgical periodontal treatment (comment). JAMA 2014;311(18): 1919-1920. 12. Merchant AT. Hemoglobin A 1c levels among patients with diabetes receiving nonsurgical periodontal treatment (comment). JAMA 2014;311(18):1919. 13. Vergnes JN. Hemoglobin A 1c levels among patients with diabetes receiving nonsurgical periodontal treatment (comment). JAMA 2014;311(18):1920-1921. 14. Engebretson SP, Hyman LG, Michalowicz BS. Hemoglobin A1c levels among patients with diabetes receiving nonsurgical periodontal treatment: reply. JAMA 2014;311(18):1921-1922.
