The control of diabetes is directed at controlling the blood glucose levels within "normal

limits", and there is clear evidence that complications can be prevented by meticulous

control of hyperglycemia [28, 29]. Monitoring the effectiveness of glycemic control is

done by measuring the levels of glycated serum proteins, in particular glycated ca-

hemoglobin (HbAlc), which because of its incorporation into the red blood cells gives an

indication of the serum glucose levels over the preceding 2 to 3 months [30].

 Impact of this study cannot be dismissed. Recently there has been attention

developed concerning the use of recombinant human IGF-1 (rhIGF-I) in the treatment of

Type 2 DM. Short term studies have demonstrated that rhIGF-1 increase insulin

sensitivity leading to improved glycemic control and also have beneficial effects on lipid

profiles [105, 106]. Furthermore free fatty acids are significantly reduced following

acute or chronic rhIGF-1 administration [107]. The mechanism by which IGF-1 exerts

these effects in vivo is unclear as IGF-1 can act through IGF-1 receptors, insulin

receptors, or both [108]. If in fact up regulation proves to be evident in gingival tissue

of diabetic patients, then perhaps some type of novel IGF-1 based local delivery system

of therapeutic agent could be utilized to treat periodontal disease as well as controlling

glycemic levels.

 The theory that polypeptide growth factors such as IGF-1 and platelet-derived

growth factor (PDGF) could be utilized to enhance regeneration of periodontal structures

has been proposed previously. A review from 1987 discussed the properties of these

natural biologic mediators to regulate the proliferation differentiation, motility and matrix

synthesis of nearly all cell types [109]. The authors felt that these growth factors could

facilitate and enhance periodontal regeneration by stimulating formation of mesenchymal