New discoveries in therapeutic targets and drug development pathways for type 2 diabetes mellitus under the guidance of precision medicine.

Type 2 diabetes mellitus (T2DM) is a complex metabolic disease involving multiple pathophysiological mechanisms, such as insulin resistance and β-cell dysfunction. Recently, the emergence of precision medicine has ushered in new ideas and strategies for the treatment of T2DM. Studies have indicated that alterations in gut microbiota and changes in multiple micro ribonucleic acids (miRNAs) are closely associated with T2DM, suggesting that regulating miRNAs and gut microbiota may become novel therapeutic targets for T2DM. In addition, the modulation of mitophagy, regulation of glucagon-like peptide-1(GLP-1) secretion, and the application of immune cell exosomes have also demonstrated significant therapeutic potential. Furthermore, regulating inhibiting serine phosphorylation, reducing proinsulin synthesis, adjusting central nervous system function, modulating transcription factors MondoA and ChREBP, adjusting Omega-3 fatty acid levels, and regulating the mammalian target of rapamycin (mTOR) signaling pathway are also considered promising therapeutic targets. The rise of precision medicine has provided a plethora of possible targets for the treatment of T2DM, spanning a wide range of areas from epigenetic modifications to gut microbiota, immune regulation, and metabolic pathways. Future research should further explore the clinical feasibility and safety of these targeted therapies while developing personalized treatment plans to improve outcomes for T2DM patients. This article highlights the latest discoveries of molecular pharmacological targets that may play a role in the pathogenesis of T2DM over the past 5 years. In addition, from the perspective of precision medicine, this review explores potential therapeutic targets for T2DM and evaluates emerging treatment strategies and drug development pathways.