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In DKD, ERS is primarily triggered by hyperglycemia, proteinuria, and the presence of AGEs and free fatty acids ( A recent study has revealed that ERS can increase the levels of unsaturated triacylglycerol precursors and reduce lipid droplet formation, leading to tubular injury and fibrosis in renal proximal tubular cell lines and STZ-induced diabetic mouse kidneys (83)

Amyloid protein aggregates can also form cytotoxic oligomers, destroy the integrity of the cell membrane, and further aggravate islet damage [249, 250]

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Details regarding sex and age and cohort size of the recruited participants can be found in the population characteristics section of this manuscript