The mechanism of DNA breakage in sperm cells in diabetes has been confirmed here by the Acridine orange study as well as the Annexin V and Comet studies, which are sensitive methods for detecting sperm cell DNA breakage and apoptosis in relation to our previous investigation by TUNEL (Katubi et al., 2019; Pal et al., 2024b). Here, ANXA5 is linked to diabetes mellitus.