Non surgical periodontal therapy reduces gingival crevicular fluid adipocytokines and improves the clinical outcomes in chronic periodontitis patients with type 2 diabetes: A systematic review and meta-analysis.

BACKGROUND: Chronic periodontitis (CP) and type 2 diabetes mellitus (DM) are linked through shared inflammatory pathways. This systematic review and meta-analysis assessed the effect of nonsurgical periodontal therapy (NSPT) on gingival crevicular fluid (GCF) adipocytokines and periodontal clinical outcomes in patients with CP and controlled type 2 DM (T2DM). MATERIALS AND METHODS: PubMed, Scopus, and EBSCOhost were searched from 1980 to 2023 in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020, with a priori registration in PROSPERO (CRD42023450510). Eligible randomized, controlled, and observational studies evaluated GCF adipocytokines by enzyme-linked immunosorbent assay (ELISA) before and after NSPT. Risk of bias (RoB) was assessed using RoB 2 and Risk of Bias in Nonrandomized Studies of Interventions, and certainty of evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation. Seven studies were included in the quantitative synthesis, and pooled effects were estimated using random-effects models (Restricted Maximum Likelihood) with standardized mean change and 95% confidence intervals. RESULTS: NSPT significantly reduced GCF adipocytokine levels in CP patients with T2DM and significantly improved periodontal clinical parameters. No significant change in adipocytokines was observed in patients with CP without diabetes, for whom comparator data were available. Although the direction of effect was consistently favorable, the evidence base was limited by small sample sizes and methodological weaknesses. CONCLUSIONS: NSPT may improve both inflammatory biomarker profiles and periodontal status in patients with CP and controlled T2DM. Adipocytokines may serve as useful biomarkers of periodontal treatment response, but the current evidence is of low certainty and should be interpreted cautiously. CLINICAL SIGNIFICANCE: Reduction of GCF adipocytokines after NSPT, together with improved periodontal indices, may provide a quantitative biomarker-based approach for monitoring treatment response. The observed adipocytokine shifts also suggest a potential pathway through which periodontal care may contribute to improved glycemic control, underscoring systemic benefits of periodontal therapy.