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BACKGROUND Diabetes and periodontitis are chronic non-communicable diseases independently associated with mortality and have a bi-directional relationship. AIMS To update the evidence for their epidemiological and mechanistic associations and re-examine the impact of effective periodontal therapy upon metabolic control (glycated hemoglobin, HbA1C). EPIDEMIOLOGY There is strong evidence that people with periodontitis have elevated risk for dysglycemia and insulin resistance. Cohort studies among people with diabetes demonstrate significantly higher HbA1C levels in periodontitis patients (vs. periodontally healthy), but there is insufficient data among people with type 1 diabetes. Periodontitis is also associated with an increased risk of incident type 2 diabetes. MECHANISMS Mechanistic links between periodontitis and diabetes involve elevations in interleukin (IL) 1-β, tumor necrosis factor-α, IL-6, receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio, oxidative stress and toll-like receptor (TLR)2/4 expression. INTERVENTIONS periodontal therapy is safe and effective in people with diabetes and it is associated with reductions in HbA1C of 0.27-0.48% after 3-months, although studies involving longer-term follow up are inconclusive. CONCLUSIONS European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF) report consensus guidelines for physicians, oral health care professionals and patients in order to improve early diagnosis, prevention and co-management of diabetes and periodontitis. This article is protected by copyright. All rights reserved.