***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 
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    Input: Purpose This study aim ed to investigate the effects of oral hygiene care by oral professionals on periodontal health in type 2 diabetes mellitus patients . Material s and Methods Diabetic participants were recruited at a university hospital and matched at a 1:1 ratio by age and gender , and r and omly allocated into intervention ( 40 people ) and control groups ( 35 people ) .  Tooth brushing instruction , oral health education , and supra-gingival scaling were implemented in all patients at baseline . This program was repeatedly conducted in intervention patients every month for 6 months , and twice at baseline and the sixth month in the control . Oral health was measured by decayed , missing , and filled teeth ( DMFT ) , plaque index , calculus index , bleeding index , patient hygiene performance ( PHP ) index , tooth mobility , Russel 's periodontal index , and community periodontal index ( CPI ) . Diabetes-related factors , oral and general health behaviors , and sociodemographic factors were interviewed as other confounding factors . An analysis of covariance ( ANCOVA ) was used with SPSS for Windows 14.0 . Results At baseline , there were no significant differences between the two groups in average of periodontal health ( calculus index , bleeding index , Russel 's periodontal index , CPI , and tooth mobility ) , diabetes-related factors ( fasting blood glucose , postpr and ial blood glucose , and HbA1c ) , and in distribution of sociodemographic factors and health behaviors . In intervention group , plaque index , dental calculus index , bleeding index , and PHP index were reduced fairly and steadily from the baseline . There were significant differences in plaque index , dental calculus index , bleeding index , PHP index , and Russel 's periodontal index between the two groups at sixth month after adjusted for baseline status . Conclusion Intensive oral hygiene care can persistently improve oral inflammation status and could slow periodontal deterioration A controlled cross-sectional study with the aim of study ing oral health in patients with type 2 diabetes was carried out in a health care district in Sweden . The study included 102 r and omly sample d diabetic patients and 102 age- and gender-matched non-diabetic subjects from the same geographical area , treated at the same Public Dental Service clinics . Oral conditions were measured at clinical and X-ray examinations . Diabetes-related variables were extracted from medical records . Diabetic patients suffered from xerostomia ( dry mouth ) to a significantly higher degree than non-diabetic controls did ( 53.5 vs. 28.4 % ; P=0.0003 ) . Sites with advanced periodontitis were more frequent in the diabetic group ( P=0.006 ) as were initial caries lesions ( P=0.02 ) . Diabetic subjects showed a greater need of periodontal treatment ( P=0.05 ) , caries prevention ( P=0.002 ) and prosthetic corrections ( P=0.004 ) . Diabetes duration or metabolic control of the disease was not related to periodontal status . However , patients with longer duration of diabetes had more manifest caries lesions ( P=0.05 ) as had those on insulin treatment when compared with patients on oral/diet or combined treatment ( P=0.0001 ) . The conclusion is that individuals with type 2 diabetes in some oral conditions exhibited poorer health . Close collaboration between the patient , the primary health care and oral health professionals could be a way of improving the diabetic patient 's general and oral health Abstract Objective : To examine the value of glycated haemoglobin ( HbA1c ) concentration , a marker of blood glucose concentration , as a predictor of  death from cardiovascular and all causes in men . Design : Prospect i ve population study . Setting : Norfolk cohort of European Prospect i ve Investigation into Cancer and Nutrition ( EPIC-Norfolk ) . Subjects : 4662 men aged 45 - 79 years who had had glycated haemoglobin measured at the baseline survey in 1995 - 7 who were followed up to December 1999 . Main outcome measures : Mortality from all causes , cardiovascular disease , ischaemic heart disease , and other causes . Results : Men with known diabetes had increased mortality from all causes , cardiovascular disease , and ischaemic disease ( relative risks 2.2 , 3.3 , and 4.2 , respectively , P < 0.001 independent of age and other risk factors ) compared with men without known diabetes . The increased risk of death among men with diabetes was largely explained by HbA1c concentration . HbA1c was continuously related to subsequent all cause , cardiovascular , and ischaemic heart disease mortality through the whole population distribution , with lowest rates in those with HbA1c concentrations below 5 % . An increase of 1 % in HbA1c was associated with a 28 % ( P<0.002 ) increase in risk of death independent of age , blood pressure , serum cholesterol , body mass index , and cigarette smoking habit ; this effect remained ( relative risk 1.46 , P=0.05 adjusted for age and risk factors ) after men with known diabetes , a HbA1c concentration ≥7 % , or history of myocardial infa rct ion or stroke were excluded . 18 % of the population excess mortality risk associated with a HbA1c concentration ≥5 % occurred in men with diabetes , but 82 % occurred in men with concentrations of 5%-6.9 % ( the majority of the population ) . Conclusions : Glycated haemoglobin concentration seems to explain most of the excess mortality risk of diabetes in men and to be a continuous risk factor through the whole population distribution . Preventive efforts need to consider not just those with established diabetes but whether it is possible to reduce the population distribution of HbA1c through behavioural means Despite long-st and ing critiques of the conduct of underpowered clinical trials , the practice not only remains widespread , but also has garnered increasing support . Patients and healthy volunteers continue to participate in research that may be of limited clinical value , and authors recently have offered 2 related arguments to support the validity and value of underpowered clinical trials : that meta- analysis may " save " small studies by providing a means to combine the results with those of other similar studies to enable estimates of an intervention 's efficacy , and that although small studies may not provide a good basis for testing hypotheses , they may provide valuable estimates of treatment effects using confidence intervals . In this article , we examine these arguments in light of the distinctive moral issues associated with the conduct of underpowered trials , the disclosures that are owed to potential participants in underpowered trials so they may make autonomous enrollment decisions , and the circumstances in which the prospect s for future meta-analyses may justify individually underpowered trials . We conclude that underpowered trials are ethical in only 2 situations : small trials of interventions for rare diseases in which investigators document explicit plans for including their results with those of similar trials in a prospect i ve meta- analysis , and early-phase trials in the development of drugs or devices , provided they are adequately powered for defined purpose s other than r and omized treatment comparisons . In both cases , investigators must inform prospect i ve subjects that their participation may only indirectly contribute to future health care benefits Measurement of glycohemoglobin ( GHb ) is widely used in patients with diabetes mellitus as a monitor of long-term glycemic control (1)(2)(3 ) . In addition , prospect i ve r and omized clinical trials , most notably the Diabetes Control and Complications Trial ( DCCT ) and the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) , have demonstrated that GHb is a measure of the risk for the development of diabetes complications (4)(5 ) . GHb is therefore an integral component of the management of patients with diabetes . GHb comprises several different hemoglobin-glucose adducts , including hemoglobin A1a ( HbA1a ) , HbA1b , and HbA1c . More than 30 different methods are commercially available to measure GHb . Together these factors have led to considerable variation in reference intervals and results reported by different laboratories . When the DCCT was published in 1993 , the lack of st and ardization of GHb methods produced very wide variability among methods , with values ranging from 4.0 % to 8.1 % on the same blood sample ( 6 ) . In the United States , the NGSP ( previously known as the National Glycohemoglobin St and ardization Program ) has reduced interlaboratory variation ( 7 ) . Using a st and ardization process based on the DCCT reference method , the NGSP has promoted a dramatic improvement in comparability of GHb values among laboratories ( 3 ) . Data from the 2003 GH2 survey from the College of American Pathologists indicated that ≥98 % of participating laboratories use NGSP-certified methods and report results as HbA1c or HbA1c equivalents ( 3 ) . Analogous st and ardization programs in Sweden and Japan (8)(9 ) , established to harmonize GHb results , have also reduced variability among GHb results . More recently , the IFCC Working Group on HbA1c St and ardization prepared primary reference material s of pure HbA1c and HbA0 and developed a reference method for HbA1c ( 10 ) . They defined HbA1c as the stable adduct of glucose to the N-terminal valine of the β-chain of hemoglobin . In the reference method , hemoglobin is cleaved Background Periodontitis is a common , chronic inflammatory disease caused by gram-negative bacteria leading to destruction of tissues supporting the teeth . Epidemiological studies have consistently shown increased frequency , extent and severity of periodontitis among diabetic adults . More recently , some controlled clinical trials have also suggested that periodontal treatment could improve glycaemic control in diabetic patients . However current evidence does not provide sufficient information on which to confidently base any clinical recommendations . The main objective of this clinical trial is to assess whether periodontal treatment could lead to a decrease in glycated haemoglobin levels in metabolically unbalanced diabetic patients suffering from chronic periodontitis . Methods The DIAPERIO trial is an open-label , 13-week follow-up , r and omized , controlled trial . The total target sample size is planned at 150 participants , with a balanced ( 1:1 ) treatment allocation ( immediate treatment vs delayed treatment ) . Periodontal treatment will include full mouth non-surgical scaling and root planing , systemic antibiotherapy , local antiseptics ( chlorhexidine 0.12 % ) and oral health instructions . The primary outcome will be the difference in change of HbA1c between the two groups after the 13-weeks ' follow-up . Secondary outcomes will be the difference in change of fructosamine levels and quality of life between the two groups . Discussion The DIAPERIO trial will provide insight into the question of whether periodontal treatment could lead to an improvement in glycaemic control in metabolically unbalanced diabetic patients suffering from periodontitis . The results of this trial will help to provide evidence -based recommendations for clinicians and a draft framework for design ing national health policies . Trial registration Current Controlled Trials IS RCT 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 associated with a reduction in level of glycated hemoglobin . Control of periodontal infections should thus be an important part of the overall management of diabetes mellitus patients BACKGROUND Periodontitis is a major cause of tooth loss among adults . Several studies have shown a possible systemic impact of periodontal infection , including poor glycemic control in patients with diabetes . Recently , photodynamic therapy ( PDT ) was used to successfully treat periodontal infection . PDT provides a broad spectrum antimicrobial efficacy with no local or systemic side effects . The objective of this study was to examine the effect of the adjunctive use of PDT on periodontal status and glycemic control of patients with diabetes and periodontitis . METHODS Forty-five patients with type 2 diabetes and moderate to severe chronic periodont 
    Output:
    
There is some evidence of improvement in metabolic control in people with diabetes , after treating periodontal disease .