自噬在调节大分子物质的周转中起着重要作用，通过清除受损细胞器和各种组织中的错误折叠蛋白质，包括肝脏、骨骼肌和肥胖组织，以维持细胞内环境平衡。在这些组织中，一种特定类型的自噬维持脂滴的积累，而这与肥胖和胰岛素抵抗的发展直接相关。在正常生理环境下，自噬似乎通过消除入侵病原体、蛋白聚集物和受损细胞器，并通过回收细胞成分产生能量和新的构建块来发挥保护作用。衰老也是自噬过程的关键调节因素。在营养缺乏、脂肪过剩、缺氧等应激条件下，自噬通过回收游离氨基酸来维持蛋白质合成，从而作为一种促进生存的机制。自噬失调已在数种与衰老相关疾病中发现，包括2型糖尿病、癌症和神经退行性疾病。因此，针对自噬可以成为预防糖尿病相关并发症进展的有希望的治疗策略。我们的文章全面概述了自噬过程的理解，包括其类型、机制、调节及其在2型糖尿病和相关并发症的病理生理学中的作用。我们还探讨了自噬在β细胞、胰岛素抵抗、蛋白聚集物清除（如胰岛淀粉样多肽）和各种胰岛素敏感组织的稳态中的重要性。这将为开发新的治疗策略为糖尿病相关并发症铺平道路。版权所有©2023 Elsevier B.V.。

Autophagy is essential in regulating the turnover of macromolecules via removing damaged organelles, misfolded proteins in various tissues, including liver, skeletal muscles, and adipose tissue to maintain the cellular homeostasis. In these tissues, a specific type of autophagy maintains the accumulation of lipid droplets which is directly related to obesity and the development of insulin resistance. It appears to play a protective role in a normal physiological environment by eliminating the invading pathogens, protein aggregates, and damaged organelles and generating energy and new building blocks by recycling the cellular components. Ageing is also a crucial modulator of autophagy process. During stress conditions involving nutrient deficiency, lipids excess, hypoxia etc., autophagy serves as a pro-survival mechanism by recycling the free amino acids to maintain the synthesis of proteins. The dysregulated autophagy has been found in several ageing associated diseases including type 2 diabetes (T2DM), cancer, and neurodegenerative disorders. So, targeting autophagy can be a promising therapeutic strategy against the progression to diabetes related complications. Our article provides a comprehensive outline of understanding of the autophagy process, including its types, mechanisms, regulation, and role in the pathophysiology of T2DM and related complications. We also explored the significance of autophagy in the homeostasis of β-cells, insulin resistance (IR), clearance of protein aggregates such as islet amyloid polypeptide, and various insulin-sensitive tissues. This will further pave the way for developing novel therapeutic strategies for diabetes-related complications.Copyright © 2023 Elsevier B.V. All rights reserved.