## 4 Discussion  
This study addresses a significant research gap regarding the prevalence of oral candidal lesions in type 2 DM patients within a specific demographic area. While the general population may also experience such lesions, focusing on DM patients is crucial, as integrating this knowledge into their management protocols can improve clinical outcomes. Our study observed all recognized and previously described oral candidal lesions, including PMC, EC, CHC, DS, AC, MRG, and _Candida_-associated dry mouth. Surprisingly, only 17.6% (Table 1) of type 2 DM patients exhibited _Candida_-related mucosal lesions, which is a lower prevalence than expected. An extensive literature review did not identify comparable \begin{table}
\begin{tabular}{c c c c} \hline
**Feature** & **DM with Candidal** & **DM Without Candidal** & **X\({}^{2}\) Test** \\  & **Lesions (n \%)** & **Lesions (n \%)** & **\(p\) Value** \\ \hline
**1. Age in years** & & & \\ \(\leq\)60 & 26 (7.38) & 148 (42.04) & 0.153 \\ \(\geq\)61 & 37 (10.51) & 141 (40.05) & \\ \hline
**2. Gender** & & & \\ Male & 31 (8.80) & 83 (23.57) & 0.002 \\ Female & 32 (9.09) & 206 (58.52) & \\ \hline
**3. Race** & & & \\ Sinhala & 54 (15.34) & 242 (68.75) & 0.73 \\ Tamil & 5 (1.42) & 20 (5.68) & \\ Muslim & 4 (1.13) & 27 (7.67) & \\ \hline
**4. Duration following diagnosis in** & & & \\
**years** & 44 (12.5) & 227 (64.48) & 0.173 \\ \(\leq\)15 & 19 (5.39) & 62 (17.61) & \\ \hline
**5. Relationship with other NCDs** & & & \\ DL + HTN & 36 (10.22) & 157 (44.60) & 0.848 \\ Other NCDs present & 12 (3.40) & 53 (15.05) & \\ No other NCDs & 15 (4.26) & 79 (22.44) & \\ \hline
**6. Glycemic level (mg/dL)** & & & \\ \(\leq\)110 & 16 (4.54) & 89 (25.28) & 0.396 \\ \(\geq\)111 & 47 (13.35) & 200 (56.81) & \\ \hline \end{tabular}
\end{table} 
Table 2: Comparison of clinicopathological presentations of patients with and without candidal lesions. \begin{table}
\begin{tabular}{c c c c c c} \hline
**Risk Factors** & **DM with Candidal** & **DM Without Candidal** & **X\({}^{2}\)** & **df** & **_p_** \\  & **Lesions (n\%)** & **Lesions (n\%)** & **X\({}^{2}\)** & **df** & **_p_** \\ \hline
**1. Denture** & & & & & \\ Denture wearer & 21 (33.33) & 73 (25.3) & 1.723 & 1 & 0.189 \\ Non-denture wearer & 42 (66.7) & 216 (74.7) & & & \\ \hline
**2. Smoking** & & & & & \\ Present & 14 (33.3) & 49 (15.8) & 7.733 & 1 & 0.005 \\ Absent & 28 (66.7) & 261 (84.2) & & & \\ \hline
**3. Betel chewing** & & & & \\ Present & 21 (28.4) & 42 (15.1) & 7.004 & 1 & 0.008 \\ Absent & 53 (71.6) & 236 (84.9) & & & \\ \hline
**4. Alcohol misuse** & & & & \\ Present & 13 (23.6) & 50 (16.8) & 1.461 & 1 & 0.227 \\ Absent & 42 (76.4) & 247 (83.2) & & & \\ \hline \end{tabular}
\end{table} 
Table 3: Association between risk factors of DM patients and occurrence of oral candidal lesions. studies focusing exclusively on oral candidal lesions in DM patients. Instead, our findings were compared with studies examining oral _Candida_ carriage rates, which range from 13.7% to 81% in DM patients [5; 11], and studies evaluating specific oral candidal lesions. A Sri Lankan study reported an oral _Candida_ carriage rate of 81%, with 33% of patients having counts exceeding 2000 CFU/mL [11]. [PERSON] et al. highlighted challenges in diagnosing _Candida_-induced lesions without the detection of pathogenic hyphae in exfoliative cytology [5], which was a challenge also encountered in our study. A statistically significant male predisposition was observed among patients with oral candidal lesions, aligning with studies conducted in India and Saudi Arabia [12; 13]. However, [PERSON] et al. [11] reported a female predilection for _Candida_ carriage in Sri Lankan DM patients. This discrepancy may be due to the higher prevalence of risk habits such as smoking and betel quid chewing among males in our study sample. Interestingly, previous studies have also indicated a higher proportion of infection-free individuals among males [14], suggesting that risk behaviors rather than gender alone may contribute to the observed differences.