ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
Chronic Periodontitis and the Risk of Diabetic Peripheral Neuropathy in Type 2 Diabetes: A Retrospective Cohort Study
Provisionally accepted
- 1Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, China
- 2The First Hospital of Hebei Medical University, Shijiazhuang, China
- 3Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
- 4The Third Hospital of Hebei Medical University, Shijiazhuang, China
- 5Clinical Research Center for Endocrine and Metabolic Diseases, Shijiazhuang, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Chronic periodontitis is a common inflammatory condition that may contribute to systemic inflammation and microvascular complications in type 2 diabetes mellitus (T2DM). However, longitudinal evidence linking periodontitis to diabetic peripheral neuropathy (DPN) remains scarce. Objective: To investigate whether chronic periodontitis is associated with an increased risk of incident DPN in patients with T2DM. Methods: We conducted a single-center retrospective cohort study using electronic medical records from 2017 to 2022. A total of 3,996 T2DM patients without baseline DPN were included, of whom 318 had incident chronic periodontitis. Propensity score matching (1:1) was applied to balance baseline characteristics, resulting in 604 patients (302 with periodontitis, 302 without). The primary outcome was incident DPN, identified using ICD-10 codes and confirmed by neurologist/endocrinologist diagnosis or abnormal nerve conduction studies. Cox proportional hazards models were used to estimate hazard ratios (HRs) adjusted for age, sex, diabetes duration, HbA1c, health insurance type, and metformin use. Results: Over a median follow-up of 3.8 years, the incidence of DPN was significantly higher in the periodontitis group (42.7% vs. 27.5%, P < 0.001). The adjusted HR for DPN associated with chronic periodontitis was 1.63 (95% CI: 1.22–2.18, P < 0.001). Subgroup analyses confirmed consistent associations across age, sex, and glycemic control strata. Sensitivity analyses, including alternative matching, lag-time analysis, and exclusion of metformin users, supported the robustness of the findings. Conclusion: Chronic periodontitis is an independent risk factor for the development of DPN in patients with T2DM. These findings highlight the importance of integrated oral health management in diabetes care to potentially mitigate neuropathic complications.
Keywords: Chronic Periodontitis, cohort study, Diabetic peripheral neuropathy, risk factor, type 2 diabetes
Received: 08 Jan 2026; Accepted: 06 Feb 2026.
Copyright: © 2026 Guo, Zhang, Yang, Guo, Dong, Wang, Zhang and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Huimin Zhou
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.