Summary: In a small trial in type 2 diabetic patients with stage-II periodontitis, periodontal cleaning improved gum parameters in both groups with no added benefit from hyaluronic acid gel, though HbA1c fell significantly only in the hyaluronic acid group.
PICO Summary
| Element | Detail |
|---|---|
| Population | 26 controlled (HbA1c <7%) type 2 diabetic patients with stage-II grade B periodontitis. |
| Intervention | Professional mechanical plaque removal plus topical hyaluronic acid gel (n=13). |
| Comparison | Professional mechanical plaque removal alone (n=13). |
| Outcome | Clinical attachment level, pocket depth, bleeding, plaque, defect depth, and bone density improved significantly in both groups (p<0.05), with no significant between-group difference. HbA1c decreased significantly only in the hyaluronic acid group (p<0.05). |
Hyaluronic acid gel added to periodontal cleaning in type 2 diabetes
RCT · type 2 diabetes · stage-II periodontitis · 6 months
Mechanical cleaning improved clinical attachment level in both arms with no added benefit from hyaluronic acid gel. HbA1c fell significantly only in the gel arm, an isolated and likely chance signal in this 26-patient trial.
Expert Commentary
The diabetes-periodontitis link is solid and clinically actionable, so I welcome trials in this space, but the framing here needs correcting. On the primary periodontal endpoints, hyaluronic acid added nothing: both arms improved with mechanical cleaning and there was no significant difference between them, so describing this as hyaluronic acid improving gum disease overstates the result. The one genuinely distinguishing finding was that HbA1c fell significantly only in the gel group, which is intriguing but hard to interpret, with twenty-six patients split into two arms of thirteen, an isolated between-group glycaemic signal in the absence of any periodontal advantage could easily be noise or chance, and the magnitude is not one I would lean on. Can I use this with my patients? The durable message is the one that was already true and is reinforced here: periodontal treatment matters in diabetes and mechanical cleaning works, so every diabetic patient deserves periodontal screening and care. I would not, on this evidence, recommend hyaluronic acid gel specifically for glycaemic benefit. A larger trial powered for HbA1c as a primary endpoint would be needed before that claim holds.
References
Al-Abbadi R, Shemais N, Nawwar A, Fawzy El-Sayed KM. Non-surgical periodontal therapy with and without hyaluronic acid gel in type 2 diabetic stage-II periodontitis patients: a randomized clinical trial. BMC Oral Health. 2025;25(1):1166. doi:10.1186/s12903-025-06485-2