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Recent studies have demonstrated that patients with diabetes experience substantial alterations in gut microbiota composition, potentially exacerbating gastrointestinal symptoms. Microbial metabolites may modulate neurotransmitter synthesis and release, directly affecting autonomic nerve function, while dysbiosis amplifies oxidative stress and inflammation, further compromising the enteric nervous system and worsening DGAN. Advances in multi-omics technologies now provide deeper insights into molecular mechanisms of DGAN and its interactions with microbiota. Early diagnosis leveraging biomarkers, gut microbiota analysis, and advanced imaging promises more effective interventions. Emerging therapeutic strategies targeting oxidative stress, inflammation, and gut microbiota represent promising approaches for managing DGAN. 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