The Emerging Role of Extracellular Vesicles in Diabetes and Complications: Mechanistic Insights and Translational Prospects

Siyuan Liu¹Zhicheng Pan¹Xuzhuo Chen¹Zhenlin Wang²Wei Zhong²Jitao Ling³Yixuan Chen⁴Panpan Xia²Deju Zhang⁵Xiao Liu⁶Peng Yu^3*Zhen Hu^7*Jing Zhang^4*

• ¹The Second Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China, Nanchang, China
• ²The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China, Nanchang, China
• ³Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Nanchang University, Nanchang, China, Nanchang, China
• ⁴Department of Anesthesiology, The Second Affiliated Hospital, Nanchang University, Nanchang, China, Nanchang, China
• ⁵Food and Nutritional Sciences, School of Biological Sciences, The University of Hong Kong, Hong Kong, China, Hong Kong, China
• ⁶Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China, Nanchang, China
• ⁷Department of Ultrasound, The Second Affiliated Hospital, Nanchang University, Nanchang, China, Nanchang, China

Extracellular vesicles (EVs), particularly exosomes, have emerged as key players in diabetes pathogenesis, diagnosis, and therapy. They regulate intercellular communication, influence islet function, and contribute to diabetic complications such as retinopathy, nephropathy, and cardiomyopathy. Their potential as liquid biopsy biomarkers and engineered therapeutic carriers— delivering nucleic acids, proteins, or stem cell-derived regenerative signals—offers promising avenues for diabetes management. However, there are some critical challenges in clinical translation. Future research must prioritize (1) scalable GMP-compliant production with rigorous quality control, (2) targeted delivery systems via ligand modification or biomimetic engineering, (3) improved biocompatibility through cargo optimization and stealth coatings, and (4) large-scale clinical trials to validate efficacy and safety. Addressing these hurdles is essential to harness EVs' full potential and accelerate their transition into mainstream diabetic care.