Diabetes mellitus is a rapidly escalating worldwide health issue that involves intricate molecular, metabolic, and systemic dysregulation. In addition to hyperglycemia, disease pathogenesis involves β-cell dysfunction, insulin resistance, mitochondrial dysfunction, endoplasmic reticulum stress (ER stress), redox imbalance, lipotoxicity, chronic inflammation, and inappropriate epigenetic modifications. New evidence also emphasizes the participation of mechanotransduction, ion channel signaling, circadian regulation, and organ cross-talk among the pancreas, liver, adipose tissue, skeletal muscle, heart, brain, and gut in modulating disease heterogeneity and progression. This review highlights updates of molecular mechanisms in diabetes, focusing on the β-cell response to stress, the AMPK–Sirtuin 1 (or PGC-1α) signaling pathway, mitochondrial quality control, mechanosensitive ion channels, immunometabolic crosstalk, and epigenetic regulation. We consider the increasing importance of multi-omics methods for early identification of pathogenic signatures and integration of artificial intelligence to enable precision stratification and therapeutic tailoring. Finally, we highlight novel experimental and translational tools, such as iPSC-derived β-cells or organoids, CRISPR-based gene editing, sophisticated metabolic imaging, and electrophysiology. Taken together, this review shifts the paradigm of diabetes as a system-level network disease and emphasizes the importance of data-driven multi-target strategies for prevention and reduction in long-term complications.
Sazdova et al. (Fri,) studied this question.