Stem cell-derived exosomes preserve diabetic islet function: a systematic review and meta-analysis of preclinical studies

Diabetes remains an incurable disease, and emerging evidence suggests that exosomes may offer promising therapeutic potential for both diabetes and its complications. However, their specific effects on pancreatic islet function are still under investigation. This meta-analysis aimed to evaluate the efficacy of stem cell-derived exosomes (SC-Exs) in preserving islet function in diabetes. A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science databases was conducted from inception to May 1, 2025, to identify studies assessing the impact of SC-Exs on islet function in diabetic models. Data on insulin levels, islet quantity, and inflammatory markers were extracted and analyzed using Stata 14.0 and Review Manager (RevMan) 5 software. Ten eligible studies were included in the meta-analysis. Compared with controls, SC-Exs significantly increased insulin levels (SMD = 10.09, 95% CI: 7.97–12.21, P < 0.00001) and islet quantity (SMD = 3.33, 95% CI: 1.47–5.20, P = 0.0005). Moreover, SC-Exs consistently promoted islet proliferation, inhibited cell death, and suppressed inflammatory responses in diabetic models. These findings suggest that SC-Ex treatment effectively preserves pancreatic islet structure and function, highlighting its potential as a novel and promising therapeutic approach for diabetes management. Further high-quality studies are warranted to confirm its efficacy, safety, and clinical applicability.