***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM To evaluate associations between glycaemic control and periodontitis progression among Gullah African Americans with type-2 diabetes mellitus ( T2DM ) . MATERIAL S AND METHODS From an ongoing clinical trial among T2DM Gullah , we extracted a cohort previously in a cross-sectional study ( N=88 ) . Time from baseline ( previous study ) to follow-up ( trial enrollment , before treatment interventions ) ranged 1.93 - 4.08 years [ mean=2.99 , st and ard deviation (SD)=0.36 ] . We evaluated tooth site-level periodontitis progression [ clinical attachment loss ( CAL ) worsening of > or = 2 mm , periodontal probing depth ( PPD ) increases of > or = 2 mm and bleeding on probing ( BOP ) from none to present ] by glycaemic control status ( well-controlled = HbA(1c)<7 % , poorly-controlled = HbA(1c ) > or = 7 % ) using multivariable generalized estimating equations logistic regression , nesting tooth sites/person . RESULTS Poorly-controlled T2DM ( 68.18 % ) was more prevalent than well-controlled T2DM ( 31.82 % ) . Proportions of tooth sites/person with CAL progression between baseline and follow-up ranged 0.00 - 0.59 ( mean=0.12 , SD=0.12 ) , while PPD and BOP progression ranged 0.00 - 0.44 ( mean=0.09 , SD=0.11 ) and 0.00 - 0.96 ( mean=0.24 , SD=0.18 ) , respectively . Site-level PPD at baseline was a significant effect modifier of associations between poorly-controlled T2DM and site-level CAL and PPD progression [ adjusted odds ratios ( OR ) according to poorly-controlled T2DM among PPD at baseline=3 , 5 and 7 mm , respectively : CAL progression=1.93 , 2.64 , and 3.62 , PPD progression=1.98 , 2.76 , and 3.84 ; p<0.05 for all ] . Odds of site-level BOP progression were increased ( OR=1.24 ) for poorly-controlled T2DM , yet the results were not significant ( p=0.32 ) . CONCLUSIONS These findings from a distinct , homogenous population further support the clinical relevance of identifying patients with poor glycaemic control and periodontitis , particularly among those with disparities for both diseases AIM To evaluate the clinical , microbiological and immunological effects of systemic doxycycline as an adjunct to scaling and root planing ( SRP ) in chronic periodontitis patients with well-controlled type 2 diabetes . MATERIAL S AND METHODS Sixty-six patients compliant to oral hygiene ( Hygiene Index < 20 % ) allocated to either a test ( systemic doxycycline for 21 days ) or a control ( placebo ) group participated in the present r and omized controlled trial ( RCT ) . Clinical assessment s were recorded at baseline , 3 and 6 months after therapy and included clinical attachment level ( CAL ) , set as the primary outcome of the study , probing pocket depth ( PPD ) , recession ( RE ) and bleeding on probing ( BOP ) . At the same time points , counts of 15 subgingival species were evaluated by " checkerboard " DNA-DNA hybridization , gingival crevicular fluid sample s were analysed for matrix metalloproteinase-8 ( MMP-8 ) by ELISA and HbA1c levels were determined . Comparisons between and within groups were performed by non-parametric tests ( Mann-Whitney , Wilcoxon signed-ranks and z-test for proportions with Bonferroni corrections ) at the 0.05 level . RESULTS No major differences were noticed in clinical and microbiological parameters of periodontal disease or levels of MMP-8 between the two groups . CONCLUSIONS Adjunctive systemic doxycycline does not seem to significantly enhance the effects of SRP in well-controlled diabetes type 2 patients Purpose The purpose of study was to compare glycemic control using glycated hemoglobin levels ( HbA1c ) in diabetic patients with chronic generalized periodontitis ( CGP ) undergoing scaling and root planing ( SRP ) with and without systemic doxycycline . Methods Fifty subjects with type 2 diabetes mellitus ( T2DM ) and CGP receiving antidiabetic therapy were selected for study . The selected subjects were r and omly assigned to two groups ( test group [ TG ] and control group [ CG ] ) comprising 25 patients each . The TG received SRP followed by systemic doxycycline . The CG received treatment with SRP only . The periodontal parameters were recorded at baseline ( day zero ) , and every 1 month for 4 months and included probing depth , clinical attachment level , plaque index , gingival index , and HbA1c level were recorded at baseline ( day zero ) and at the end of 4 months . Results A statistically significant effect was demonstrated for the periodontal parameters for both the TG and CG . HbA1c values did not show a statistically significant difference in the treatment group as compared to the CG . Conclusions The authors concluded that nonsurgical periodontal therapy improved glycemic control in patients with T2DM in both groups , but no statistical difference was observed with adjunctive systemic doxycycline therapy . A further study with a larger sample size is required Current evidence suggests that periodontal infection may aggravate  diabetes control .  The aim of this study was to determine the changes in the frequency with which Porphyromonas gingivalis , Tannerella forsythia , Treponema denticola and Aggregatibacter actinomycetemcomitans were detected in patients with diabetes with the use of non-surgical therapy plus azithromycin in a r and omized clinical trial . One hundred and five ( 105 ) patients with diabetes and chronic periodontitis were r and omly assigned to three treatment groups : subgingival mechanical therapy with azithromycin , subgingival mechanical therapy with placebo and supragingival prophylaxis with azithromycin . Complete periodontal clinical examinations and detection of periodontal pathogens using polymerase chain reaction were carried out at baseline , 3 , 6 and 9 months after periodontal therapy . The frequency with which Porphyromonas gingivalis , Treponemadenticola and Aggregatibacter actinomycetemcomitans were detected decreased at 3 months in all groups . Tannerella forsythia increased after3 months in all groups . All organisms had similar frequencies at 9 months in all groups . Subgingival mechanical therapy with adjunctive azithromycin had no additional effect on the frequency with which the periodontal pathogens investigated were detected in patients with diabetes AIM Diabetic patients have more severe periodontal destruction , but periodontal therapy can improve metabolic control . Recently , interest has focused on the use of subantimicrobial dose doxycycline ( SDD ) as a treatment paradigm . Therefore , this study was undertaken to evaluate clinical efficacy of SDD with scaling and root planning ( SRP ) in chronic periodontitis patients with diabetes . METHODS AND MATERIAL S Twenty chronic periodontitis patients with diabetes mellitus were r and omly allocated to either a test and a control group . Clinical measurements were recorded at baseline and at six months for probing pocket depth ( PPD ) , clinical attachment level ( CAL ) , and gingival recession ( GR ) . After SRP , patients in the test group were instructed to take SDD 20-mg capsules twice a day while patients in the control group took a placebo twice a day . Both groups were on this regimen for a six-month period . RESULTS A greater reduction in mean PPD was demonstrated in patients in the test group compared to the control group . The mean CAL increase observed in the test group was significantly greater ( 0.67 mm ) than that in the control group . CONCLUSION It can be concluded that SRP , in conjunction with the SDD therapy described , is more effective then SRP alone in terms of CAL gain and PPD reduction in diabetic patients with severe periodontal disease . CLINICAL SIGNIFICANCE Given the widespread prevalence of both chronic periodontitis and diabetes , the proposed treatment approach will prove to be of great value and contribute significantly to the overall health of the patients Objectives : To evaluate the effects of systemic doxycycline on clinical and microbiological parameters of diabetic subjects with chronic periodontitis . Methods : This 9-month multi-center , r and omized , parallel , single-blinded study was conducted from different hospitals in Riyadh , Saudi Arabia between April 2010 and December 2010 . A total of 76 diabetic subjects with chronic periodontitis were r and omized into 2 groups : control group ( CG ) received only scaling and root planing ( SRP ) , and the treatment group ( TG ) receiving systemic doxycycline during the reevaluation visit 45 days after the completion of SRP .  Probing pocket depth , clinical attachment level , gingival index , plaque index , and bleeding on probing were collected at baseline , 45 days after SRP , and one , 3 , and 6 months after the use of systemic doxycycline . Microbiological analysis comprised the detection of Tannerella forsythia ( Tf ) , Aggregatibacter actinomycetemcomitans ( Aa ) , Porphyromonas gingivalis ( Pg ) , and Prevotella intermedia ( Pi ) by polymerase chain reaction method . Results : Sixty-eight ( 33 CG and 35 TG ) subjects completed the study . Greater reduction in the population of Tf , Pg , and Pi were observed in TG compared with CG in the first month after the administration of systemic doxycycline . The TG showed a significant improvement in gingival index scores compared with the CG ( p<0.05 ) by the end of the first and 6 months after the administration of doxycycline . Conclusion : Adjunct systemic doxycycline can be associated with a reduction of Tf , Pg , and Pi in the first month after the administration of doxycycline with an improvement in the GI OBJECTIVE To investigate the effectiveness of short-term adjunctive subantimicrobial dose doxycycline ( SDD ) treatment in patients with diabetes mellitus type 2 and chronic periodontitis ( CP ) . METHODS Thirty-four patients with CP and type 2 diabetes mellitus were included in the placebo-controlled , double-blind study . After scaling and root planing ( SRP ) , patients were r and omly assigned to two groups , receiving either SDD or placebo bid for 3 months . The probing depth ( PD ) , clinical attachment level ( CAL ) , bleeding on probing ( BOP ) , approximal plaque index , glycated hemoglobin ( HbA1c ) level were recorded and gingival crevicular fluid ( GCF ) sample s were collected at baseline and after 3-month therapy for the estimation of matrix metalloproteinase-8 levels . RESULTS Clinical attachment level , PD , and BOP improved significantly in both groups after therapy ( P < 0.05 ) . The statistically significant difference between the two groups after the therapy was observed only in PD in tooth sites with initial PD ≥ 4 mm ( SRP + placebo : 3.41 ± 0.6 mm vs SRP + SDD : 2.92 ± 0.5 mm , P < 0.05 ) . GCF matrix metalloproteinase-8 levels were significantly reduced only in SRP + SDD group ( P < 0.01 ) . There were no changes in HbA1c levels after therapy . CONCLUSION The short-term administration of SDD gives significant benefit at tooth sites with moderate disease ( PD ≥ 4 mm ) when compared to SRP alone in patients with diabetes and CP Periodontal disease is a common infection-induced inflammatory disease among individuals suffering from diabetes mellitus . The purpose of this study was to assess the effects of treatment of periodontal disease on the level of metabolic control of diabetes .  A total of 113 Native Americans ( 81 females and 32 males ) suffering from periodontal disease and non-insulin dependent diabetes mellitus ( NIDDM ) were r and omized into 5 treatment groups . Periodontal treatment included ultrasonic scaling and curettage combined with one of the following antimicrobial regimens : 1 ) topical water and systemic doxycycline , 100 mg for 2 weeks ; 2 ) topical 0.12 % chlorhexidine ( CHX ) and systemic doxycycline , 100 mg for 2 weeks ; 3 ) topical povidone-iodine and systemic doxycycline , 100 mg for 2 weeks ; 4 ) topical 0.12 % CHX and placebo ; and 5 ) topical water and placebo ( control group ) . Assessment s were performed prior to and at 3 and 6 months after treatment and included probing depth ( PD ) , clinical attachment level ( CAL ) , detection of Porphyromonas gingivalis in subgingival plaque and determination of serum glucose and glycated hemoglobin ( HbA1c ) . After treatment all study groups showed clinical and microbial improvement . The doxycycline-treated groups showed the greatest reduction in probing depth and subgingival Porphyromonas gingivalis compared to the control group . In addition , all 3 groups receiving systemic doxycycline showed , at 3 months , significant reductions ( P < or = 0.04 ) in mean HbA1c reaching nearly 10 % from the pretreatment value . Effective treatment of periodontal infection and reduction of periodontal inflammation is 
    Output:
    
The results of the meta-analyses presented a modest additional benefit of 0.14 mm ( 95 % confidence interval : 0.08 - 0.20 ) in reducing PPD but no further benefit in CAL gain .
CONCLUSION When the data for all antibiotic protocol s were considered together for the treatment of periodontitis patients with DM , a significant , albeit small , reduction of PPD and no improvement in CAL gain was observed .
When the antibiotic protocol s were analysed separately , the combination of amoxicillin plus metronidazole yielded the best results for PPD