An umbrella review of systematic reviews examining the relationship between type 2 diabetes and periodontitis: Position paper from the Canadian Dental Hygienists Association.
Bibliographic record
Abstract
Previous research has confirmed strong associations between periodontitis and diabetes mellitus (DM), supporting DM as a risk factor for periodontal disease and suggesting a bidirectional relationship. Causal relationships have not been confirmed. Aim: The aim of this paper is to review the most current evidence of the nature of this relationship and examine whether non-surgical periodontal therapy (NSPT) significantly lowers glycemic (HbA1c) control. Methods: The PICO question was, "For individuals with type 2 diabetes mellitus (T2DM) and periodontitis, will non-surgical periodontal therapy (NSPT), as compared to no treatment, improve the individual's glycemic control as measured by HbA1c." Only systematic reviews (SRs) with or without a meta-analysis (MA) of randomized controlled trials (RCTs) or umbrella reviews of SRs and MAs of RCTs published in the English language between 2007 and 2019 were included. Several databases were searched as per their protocols. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality. Results: Of 54 records retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 5 SRs/MAs and 3 umbrella reviews of SRs/MAs were selected. All 5 SRs/MAs reported reductions in HbA1c levels 3 months following NSPT, but effect sizes were small and 2 were not statistically significant. The 3 umbrella reviews consistently reported small reductions in HbA1c, but high levels of heterogeneity and moderate to high risk of bias. The Bradford Hill criteria failed to support a causal relationship between periodontitis and T2DM. Conclusions: Whether NSPT compared with no treatment in persons with T2DM improves the individual HbA1c remains unclear as does the exact nature of the relationship between periodontitis and T2DM.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.101 | 0.167 |
| Meta-epidemiology (narrow) | 0.004 | 0.003 |
| Meta-epidemiology (broad) | 0.012 | 0.009 |
| Bibliometrics | 0.039 | 0.033 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.010 | 0.009 |
| Open science | 0.007 | 0.008 |
| Research integrity | 0.009 | 0.006 |
| Insufficient payload (model declined to judge) | 0.011 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".