PKM and diabetes mellitus: SIRT3 deficiency is one of the fibrotic phenotypes in diabetes that leads to PKC activation and PKM2 tetramer-to-dimer interconversion; ultimately, these processes alter the metabolic switch toward defective metabolism and associated mesenchymal activation in renal epithelial cells (Li et al., 2020b; Srivastava et al., 2018, 2020c).