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After quality control, 29 DM\u2009+\u2009MI patients and 33 DM patients were included in the final analysis. Gut microbial profiles were characterized using shotgun metagenomic sequencing and bioinformatics analyses. Microbial diversity, composition, and gene functions were compared between groups based on KEGG, COG, and CAZy annotations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall microbial diversity and metabolic profiles were comparable between the two groups; however, significant differences were observed in specific taxa and functional genes. Taxa enriched in the DM\u2009+\u2009MI group included Bacteroidales, Prevotellaceae, and Lachnospiraceae. In total, 510 KEGG orthology (KO) units and 21 pathways\u2014including ABC transporters, quorum sensing, and general metabolic pathways\u2014differed significantly between groups. Carbohydrate transport and metabolism, as well as glycoside hydrolase activity, represented the most enriched functional categories. Random forest models based on selected microbial species,\n                      <jats:italic>KO units<\/jats:italic>\n                      , and KEGG pathways achieved areas under the curve (AUCs) of 0.868, 0.885, and 0.820, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with DM complicated by MI exhibit distinct gut microbial compositions and functional gene signatures compared with patients with DM alone. These microbiome-based markers may contribute to early risk stratification and provide potential targets for microbiota-focused interventions to mitigate MI risk in patients with diabetes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00592-026-02648-x","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T11:03:26Z","timestamp":1770635006000},"page":"789-799","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A metagenomic study of the gut microbiome in patients with type 2 diabetes mellitus and myocardial infarction"],"prefix":"10.1007","volume":"63","author":[{"given":"Honghong","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changlin","family":"Zhai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huilin","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0647-3100","authenticated-orcid":false,"given":"Menghui","family":"Mao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"2648_CR1","doi-asserted-by":"publisher","first-page":"1513","DOI":"10.1016\/S0140-6736(16)00618-8","volume":"387","author":"Anonymous","year":"2016","unstructured":"Anonymous (2016) Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. 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