Abstract: Lysine lactylation (Kla) is a recently identified post-translational protein modification that plays a critical role in gene expression, cellular metabolism, and the pathogenesis of various diseases. However, research into the mechanisms and clinical translation of Kla in diabetic microvascular complications is still at an early stage of in-depth investigation. This review summarizes the regulatory mechanisms underlying lactylation, systematically describes the current progress of lactylation in diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy, and explores the multidisciplinary translational potential of biomarkers and targeted therapies. It aims to provide a theoretical foundation for the prevention, treatment, and drug development of diabetic microvascular complications.

Key words: Lactylation, Diabetic nephropathy, Diabetic retinopathy, Diabetic peripheral neuropathy