Tissue-specific regulatory patterns are observed: in diabetic nephropathy, it promotes podocyte injury (LARS1 lactylation) and mitochondrial dysfunction (ACSF2 modification); in retinopathy, the lactylation-FTO-CDK2 axis drives pathological angiogenesis; in gestational diabetes, histone lactylation dysregulates PI3K-Akt signaling. This evidence concerns the gene ACSF2 and diabetic kidney disease.