# Advances in the study of oral microbiota in association with T2DM: a systematic review

## TL;DR

This review explores how changes in the mouth's bacteria may be linked to the development and progression of type 2 diabetes.

## Contribution

The study systematically reviews evidence linking oral microbiota composition to T2DM, highlighting potential microbial markers.

## Key findings

- Oral microbiota composition is significantly associated with T2DM.
- Firmicutes phylum is consistently elevated in T2DM patients.
- Porphyromonas gingivalis is repeatedly linked to systemic inflammation and insulin resistance in T2DM.

## Abstract

This systematic review aimed to examine the relationship between the oral microbiota and the onset and progression of type 2 diabetes mellitus (T2DM).

A systematic review was conducted in accordance with PRISMA guidelines. Three independent reviewers searched relevant literature across multiple databases, including PubMed/Medline, Web of Science, and Scopus, covering publications from April 2000 to April 2025.

A total of 1,438 publications were initially identified, of which 34 studies met the inclusion criteria after screening, namely 23 cross-sectional studies and 11 case-control studies. These studies involved 2,062 patients with T2DM and 1,445 non-diabetic controls. All included studies reported a correlation or potential association between the oral microbiota and T2DM. Fifteen studies analyzed alpha diversity, revealing heterogeneous findings: three reported increased diversity in T2DM patients, two reported decreased diversity, and the remainder showed either no significant differences or inconsistent trends. At the phylum level, Firmicutes was consistently elevated in T2DM patients (14 studies), whereas Proteobacteria was often reduced, and findings on Bacteroidetes varied. At the genus level, Streptococcus, Porphyromonas, and Treponema were most frequently enriched in T2DM populations, with Streptococcus significantly elevated in 22 studies. Notably, Porphyromonas gingivalis was repeatedly identified as a potential contributor to systemic inflammation and insulin resistance, indicating a potential pathogenic role in the metabolic dysregulation of T2DM. Species-level analyses further revealed increased abundance of Streptococcus mutans, P. gingivalis, and T. denticola, supporting the hypothesis that oral dysbiosis is linked to T2DM pathogenesis.

There is a significant association between oral microbiota composition and T2DM. These findings highlight the potential importance of oral health monitoring as part of preventive and therapeutic strategies in the management of T2DM.