The effect of antimicrobial periodontal treatment on circulating tumor necrosis factor-alpha and glycated hemoglobin level in patients with type 2 diabetes

J Periodontol. 2001 Jun;72(6):774-8. doi: 10.1902/jop.2001.72.6.774.


Background: Tumor necrosis factor-alpha (TNF-alpha) may play an important role in insulin resistance. In this study, we hypothesized that TNF-alpha produced due to periodontal inflammation synergistically affects insulin resistance as well as TNF-alpha produced from adipose tissues in insulin-resistant type 2 diabetes patients. Therefore, to understand the effects of antimicrobial periodontal therapy on serum TNF-alpha concentration and subsequent metabolic control of diabetes, we examined the periodontal and diabetic status on 13 type-2 diabetes patients.

Methods: These patients were treated with local minocycline administration in every periodontal pocket around all existing teeth once a week for a month. Before and after treatment, the number of total bacteria in the periodontal pockets and circulating TNF-alpha concentration were measured and the HbA1c value was assessed.

Results: Antimicrobial therapy significantly reduced the number of microorganisms in periodontal pockets (P <0.01). After treatment, the circulating TNF-alpha level was significantly reduced (P <0.015). The HbA1c value was also reduced significantly (P <0.007). In addition, the 6 patients who were not receiving insulin therapy demonstrated decreased fasting insulin levels (P <0.03), and HOMA-R (P <0.03) indices. The average reductions in circulating TNF-alpha concentration and HbA1c value were 0.49 pg/ml and 0.8%, respectively.

Conclusion: The results indicate that anti-infectious treatment is effective in improving metabolic control in diabetics, possibly through reduced serum TNF-alpha and improved insulin resistance.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Blood Glucose / analysis
  • Body Mass Index
  • Dental Plaque / therapy
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / complications
  • Fasting
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A / analysis*
  • Humans
  • Insulin / blood
  • Insulin Resistance
  • Male
  • Middle Aged
  • Minocycline / administration & dosage
  • Minocycline / therapeutic use*
  • Periodontal Diseases / blood
  • Periodontal Diseases / complications
  • Periodontal Diseases / drug therapy*
  • Periodontal Index
  • Periodontal Pocket / drug therapy
  • Periodontitis / drug therapy
  • Statistics as Topic
  • Statistics, Nonparametric
  • Tumor Necrosis Factor-alpha / analysis*


  • Anti-Bacterial Agents
  • Blood Glucose
  • Glycated Hemoglobin A
  • Insulin
  • Tumor Necrosis Factor-alpha
  • Minocycline