Editorial: Nutrient metabolism and complications of type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a highly prevalent metabolic disorder characterized by chronic hyperglycemia and pervasive dysregulation of nutrient metabolism. With disease progression, diabetes-related complications represent the major adverse outcomes, markedly compromising patients' quality of life and survival while placing a considerable burden on healthcare systems 1 . Nutrient metabolism disorders are not only a core pathological feature of T2DM but also a key driver in the development of both microvascular and macrovascular complications 2,3 . Understanding the relationship between nutrient metabolism and diabetes complications, and identifying key nutrient metabolism factors influencing patient outcomes, is increasingly crucial for developing appropriate intervention strategies for patients with T2DM.Currently, there is extensive research on the relationship between nutrient metabolism and classic complications and comorbidities of diabetes 4 . However, with longer disease durations and rising case numbers, the spectrum of diabetic complications has become far more intricate. Among these, non-classic complications such as cognitive dysfunction, abnormal bone metabolism, metabolic fatty liver disease, and sarcopenia are emerging as major factors affecting patient quality of life. To address this gap, this Research Topic presents studies that elucidate the link between nutrient metabolism and non-classic complications, highlighting the predictive value of emerging indicators, as well as potential strategies for personalized nutritional intervention and clinical management.Medical nutrition therapy has a key role in T2DM management, with dietary interventions being central to improving glycaemic control and overall metabolic health.Recent evidence suggests that overall dietary patterns are more impactful than individual nutrients 5 . El-Sehrawy et al. investigated the effects of the Baltic Sea Diet Score (BSDS) and the Healthy Nordic Diet Index (HNDI) on the risk of T2DM. This case-control study identified a significant inverse association between high adherence to the Nordic diet and the risk of developing T2DM. However, dietary interventions exhibit differential effects across diverse demographic groups. A significant finding of this Research Topic is the incorporation of sex-specific considerations into the analysis. Zhang et al., using National Health and Nutrition Examination Survey (NHANES) data (2001-2018), explored the impact of diet on cardiovascular (CV)/all-cause mortality in diabetic patients, and investigated whether this relationship changed by gender. High dietary scores, assessed by the Healthy Eating Index (HEI), the Alternative Healthy Eating Index (AHEI), and the alternative Mediterranean Diet (aMED) index, were strongly associated with lower CV/all-cause mortality in males but not in females. Among the component scores of the aMED, legume intake was unfavorable for males with diabetes but was remarkably associated with lower CV/all-cause mortality in females. Taken together, these findings highlight the central role of dietary management in T2DM care, while emphasizing that biological sex is an indispensable factor that cannot be overlooked.It has become increasingly clear that nutrient metabolic imbalance acts as a molecular link connecting T2DM complications. We focus on the predictive and interventional value of nutritional and metabolic indicators in diabetic complications.