“With the rising incidence rate of diabetes, diabetes kidney disease (DKD) has become a major global health challenge. Since the introduction of the concept of "gut kidney axis" in 2011, the role of gut microbiota in the pathogenesis of DKD has attracted much attention. This article reviews the current research status of gut microbiota, explores its involvement in the pathogenesis of DKD, and summarizes prevention and treatment methods based on the "gut kidney axis" theory. Research has found that dietary regulation, intake of probiotics/prebiotics, use of metformin and new hypoglycemic drugs, as well as the application of traditional Chinese medicine formulas, can improve the structure of gut microbiota, affect the generation of metabolites, repair the intestinal mucosal barrier, and regulate the innate immune and inflammatory responses of the intestine, thereby intervening in the progression of DKD disease. Although the traditional decoction oral administration method and the complexity of traditional Chinese medicine compound ingredients pose challenges to mechanism research, increasing evidence suggests that traditional Chinese medicine may indirectly affect the occurrence and development of DKD by regulating gut microbiota, providing new ideas and methods for DKD treatment.”