Abstract / Summary
Type 2 diabetes (T2D) is increasingly recognized as a systemic network disorder in which impaired communication among endocrine, neural, immune, and microbial systems drives metabolic dysfunction and accelerates biological aging. Extending DeFronzo’s “Ominous Octet,” contemporary advances in immunometabolism, mitochondrial biology, circadian physiology, and incretin signaling demonstrate that metabolic homeostasis depends on the structural and functional integrity of dynamic inter-organ networks. Their progressive disruption contributes not only to classical insulin resistance and β-cell failure, but also to chronic low-grade inflammation (inflammaging), mitochondrial decay, autonomic dysregulation, and epigenetic age acceleration. Crucially, modern disease-modifying interventions—including multi-incretin receptor agonists, SGLT2 inhibitors, metabolic/bariatric surgery, and circadian-aligned lifestyle programs—produce pleiotropic benefits that extend far beyond simple glycemic control. These convergent effects suggest partial restoration of impaired metabolic networks rather than isolated correction of glucose abnormalities. In this review, we propose “Metabolic Rejuvenation” as a novel, unifying operational framework describing the systemic restoration of metabolic network integrity, physiological resilience, and biological adaptability. Mechanistically, we discuss how reactive aldehyde-driven glycative stress operates within a multifactorial cascade—together with chronic inflammation and organelle dysfunction—to drive metabolic network collapse and accelerate biological aging. Finally, we outline a multidimensional assessment framework spanning five measurable domains (Inflammatory, Energetic & Mitochondrial, Autonomic & Neuroendocrine, Clinical & Metabolic, and Digital & Behavioral) to quantify disease modification, β-cell preservation, and diabetes remission potential toward healthy metabolic longevity.