The effects of synbiotic supplementation along with non-surgical periodontal therapy in improving the metabolic status and inflammatory markers in type 2 diabetes mellitus patients with periodontal disease: A double-blind randomized clinical trial

BACKGROUND:Diabetes mellitus and periodontitis are two common chronic diseases with bidirectional relationship. Considering the role of oxidative stress in the pathogenesis of these two diseases, the use of nutritional supplements with antioxidant properties can be useful. The purpose of this study was to determine the effectiveness of daily synbiotic supplement in the management of patients with type 2 diabetes mellitus (T2DM) and periodontal disease (PD) under non-surgical periodontal therapy (NSPT).MATERIALS AND METHODS:In this randomized double-blind placebo controlled clinical trial, 50 patients suffering from T2DM and periodontal disease were recruited and randomly assigned to two groups: intervention group (n = 25), where one capsule of multi-species probiotic plus 100 mg fructo-oligosaccharide supplement (500 mg in each capsule) every day is given, and control group (n = 25), which received one placebo capsule containing 500 mg wheat flour for 8 weeks. At the beginning and end of the study, the serum levels of fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), the lipid profile including total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) and inflammatory markers such as tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) were measured. All subjects received NSPT including oral health education, scaling, and root planning at the beginning of study. One month after the intervention, the second NSPT was performed. The paired-sample test was used to identify within-group differences. The independent sample t-test (crude model) and the analysis of covariance or ANCOVA (adjusted model) were used to compare the results between the two groups.RESULTS:Synbiotic supplement with NSPT significantly decreased serum levels of FBG, HbA1c, TNF-α, and IL-6 compared with the baseline values (all P < 0.05). Furthermore, LDL-C levels significantly decreased compared with the baseline value in both groups (all P < 0.05). Also, the mean changes of IL-6 were significantly lower in the intervention group compared with the control group after the adjustment of confounding factors (P = 0.01).CONCLUSIONS:Synbiotic supplementation with NSPT may be beneficial in improving glycemic control and inflammation and decreasing LDL-C in patients with T2DM and PD.