The therapeutic effect of exosomes in type 2 diabetes mellitus and its complications.

Exosomes are a type of nanoscale extracellular vesicle secreted by cells, with a diameter of approximately 30-150 nm, which carry important biological molecules such as proteins, lipids, and RNA, functioning as messengers between cells and playing a central role in cell communication. Due to their involvement in various physiological and pathological processes and their low immunogenicity and good tissue penetration, exosomes have become a research hotspot for disease diagnostic markers and drug delivery carriers. Type 2 diabetes mellitus (T2DM) is a common chronic metabolic disorder characterized primarily by high blood sugar, whose core pathogenesis includes insulin resistance and the subsequent functional deficiency of pancreatic β-cells, which can lead to various serious complications over the long term. The review systematically elaborates on the key roles of exosomes from different cell sources in regulating T2DM and its complications, focusing on how these exosomes, through their specific microRNAs (miRNAs), proteins, and other active substances they carry, act on different key targets and thereby regulate core pathological processes such as insulin signaling pathways, inflammatory responses, cell apoptosis, fibrosis, and angiogenesis. Through the review of existing evidence, we aim to reveal the complex network of exosomes as intercellular messengers and provide a solid theoretical basis for their development as new diagnostic markers and targeted therapeutic strategies.