Objectives <p>This study aimed to investigate the current status and influencing factors of oral frailty in elderly patients with type 2 diabetes mellitus to inform the development of oral management programs in this population.</p> Methods <p>A total of 431 elderly patients with type 2 diabetes mellitus who visited two tertiary public hospitals in Nanchong City from March 2024 to October 2024 were enrolled in this study. The General Information Questionnaire, Oral Frailty Index-8 (OFI-8), Oral Health Assessment Tool (OHAT), Eating Assessment Questionnaire Tool-10 (EAT-10), Perceived Social Support Scale (PSSS), Geriatric Depression Scale (GDS-5), and Geriatric Self Efficacy Scale for Oral Health Scale (GSEOH) were used to investigate and assess the factors related to oral frailty.</p> Results <p>The prevalence of oral frailty in elderly patients with type 2 diabetes was 32.95% (142/431). Multivariate logistic regression analysis revealed that advanced age(OR = 1.098, 95% CI: 1.054 ~ 1.146), glycated hemoglobin (HbA1c) ≥ 7%(OR = 3.745, 95% CI: 1.203–12.647), dysphagia(OR = 8.401, 95% CI: 2.276–43.846), and poor oral health status (OR = 2.213, 95% CI: 1.134–4.394) were risk factors of oral frailty, and the number of remaining teeth ≥ 20(OR = 0.105, 95% CI: 0.046–0.217) and high oral health-related self-efficacy(OR = 0.934, 95% CI: 0.898–0.970) were protective factors against oral frailty (<i>P</i> &lt; 0.05).</p> Conclusions <p>The Integral Model of Frailty provides a new theoretical framework for the study of oral frailty. The main OF infuencing factors in the elderly patients with type 2 diabetes mellitus are age, HbA1c, dysphagia, poor oral health status, the number of remaining teeth, and oral health-related self-efficacy. Healthcare professionals should develop and implement targeted oral health management strategies for this population to improve oral health outcomes.</p>