Glycemic Variability and Gut Microbiota Metabolic Patterns: A Novel Perspective on Diabetic Complications

Emerging evidence indicates a critical link between diabetic complications and the interplay of glycemic variability and gut microbiota metabolic activity. This review comprehensively examines the regulatory effects of glycemic fluctuations on the composition and function of the gut microbiota, while elucidating the key mechanisms by which microbial metabolic reprogramming-mediated through short-chain fatty acids, bile acids, and other metabolites-disrupts host metabolic and immune homeostasis, thereby exacerbating diabetic complications. Research demonstrates that glycemic variability not only directly contributes to vascular and neuronal damage but also remodels the gut microbiota's metabolic network, triggering systemic metabolic dysregulation and chronic low-grade inflammation. Building on these findings, we explore novel therapeutic strategies targeting the gut microbiota for the prevention and management of diabetic complications. By adopting a "gut-organ axis" framework, this study unveils the cascade of interactions among glycemic variability, gut microbiota, and metabolic disturbances in the pathogenesis of diabetic complications, offering both theoretical foundations and innovative approaches for clinical intervention.