Periodontitis and Glycaemic Control: A Systematic Review and Meta-Analysis of the Impact of Periodontal Disease on Blood Glucose Levels

Background: Periodontitis, a prevalent chronic inflammatory disease, is hypothesized to negatively impact systemic health, particularly glycaemic control. This meta-analysis systematically evaluates the association and causal impact of periodontitis and its treatment on blood glucose parameters in both diabetic and non-diabetic populations. Methods: A systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted for studies published up to January 2023. Inclusion criteria encompassed observational and interventional studies reporting quantitative data on the association between periodontitis and blood glucose outcomes, primarily Haemoglobin A1c and Fasting Plasma Glucose (FPG). Random-effects models were used to calculate pooled standardized and weighted mean differences (SMD/WMD). Subgroup analyses were performed based on diabetes status and type of intervention. Results: Forty-two studies, involving a total of 15,876 participants, were included. Individuals with periodontitis exhibited significantly higher mean levels compared to controls (WMD: 0.35%; 95% CI: 0.28-0.42;). Subgroup analysis confirmed this effect was more pronounced in diabetic individuals. FPG levels were also significantly elevated in the periodontitis group (WMD: 9.8 mg/dL; 95% CI: 7.5-12.1;). Furthermore, periodontal therapy was associated with a statistically significant reduction in among diabetic patients (WMD: -0.48%; 95% CI: -0.71 to -0.25;). Conclusion: Periodontitis is a significant systemic inflammatory burden associated with impaired blood glucose regulation. This effect is particularly detrimental to glycaemic control in diabetic patients. Periodontal treatment offers a clinically relevant benefit in lowering, highlighting the need to integrate periodontal care into the comprehensive management of diabetes and metabolic health.