Exosomal MicroRNAs as theranostic tools in type 2 diabetes and its complications: mechanistic insights and clinical implications

Type 2 diabetes is a chronic and progressive metabolic disease, with a steadily increasing global incidence and prevalence, representing a major public health concern due to its substantial impact on morbidity and mortality. Type 2 diabetes is characterized by defective insulin secretion and peripheral insulin resistance, resulting in dysregulated glucose homeostasis. Optimal disease management is critical due to its association with multiple systemic complications, including diabetic retinopathy, nephropathy, neuropathy, foot ulcers, cardiomyopathy, and diabetes-related cognitive impairment. The involvement of exosomes in the initiation and progression of type 2 diabetes has recently gained considerable attention. These nanosized vesicles, secreted by virtually all cell types, play a pivotal role in mediating intercellular communication. This review highlights the potential of exosomes and their molecular cargo, particularly microRNAs, as endogenous biomarkers for the detection and monitoring of type 2 diabetes and its associated complications, while also exploring their emerging therapeutic applications.