The mediation analysis revealed that EAT accounted for 48.79% of the total effect of hsa-miR-4750-3p on CAD in T2DM.<h4>Conclusions</h4>These findings suggest that the proposed miRNA-EAT regulatory axis may be involved in the pathogenesis of diabetic atherosclerosis, with EAT appearing to partially mediate the relationship between hsa-miR-4750-3p and CAD. This evidence concerns the gene MCL1 and type 2 diabetes mellitus.