Harnessing exosomal long non-coding RNAs as a new frontier for molecular diagnostics and therapeutics in diabetes mellitus.

Exosomes are emerging as dynamic regulators of cellular crosstalk. Exosomal long non-coding RNAs (Exo-lncRNAs) are now recognized as key molecular mediators of diabetes mellitus. These molecules are interrelated with β-cell function, insulin resistance, inflammation, and diabetic complications. Key diabetes-related exo-lncRNAs include exo-P3134, which supports β-cell compensation, as well as exo-MALAT1 and exo-GAS5, which are regulators of insulin resistance and β-cell dysfunction. This review unravels the complex interplay between exo-lncRNAs and the hallmarks of diabetes, across disease pathogenesis and complications. It also spotlights the unprecedented potential of exo-lncRNAs as non-invasive biomarkers and next-generation therapeutic targets in precision medicine in diabetes. By combining mechanistic and translational evidence, this review offers the first integrative framework that positions exo-lncRNAs at the center of diabetes progression and opens new avenues for translational applications.