Pathophysiology of Diabetes Mellitus and Recent Advances in Its Treatment: An Integrative Review

Abstract

Diabetes mellitus is a multifaceted metabolic disorder with increasing global prevalence and significant health burden. It encompasses heterogeneous subtypes, including type 1, type 2, gestational, and secondary diabetes, each characterized by distinct pathophysiological mechanisms. Type 1 diabetes primarily arises from autoimmune β-cell destruction, whereas type 2 diabetes involves insulin resistance, β-cell dysfunction, and chronic metabolic stress. Recent insights into molecular pathways, including oxidative stress, inflammation, lipotoxicity, and epigenetic modifications, have expanded our understanding of disease progression and complications. Therapeutic strategies have evolved beyond conventional insulin therapy and oral antidiabetic agents, incorporating incretin-based therapies, SGLT2 inhibitors, dual and triple receptor agonists, advanced insulin delivery systems, regenerative medicine, gene- and RNA-based approaches, and AI-assisted digital health interventions. Complementary adjuncts such as nutrigenomics, microbiome modulation, exercise mimetics, circadian alignment, antioxidants, and phytochemicals further enhance metabolic regulation and patient outcomes. Despite these advances, challenges remain in accessibility, cost, long-term safety, and clinical translation. The future of diabetes management lies in precision medicine, integrating molecular, genetic, and lifestyle insights to enable personalized and potentially curative therapies. This review highlights current understanding of diabetes pathophysiology, summarizes conventional and emerging treatments, and emphasizes integrative strategies for holistic disease management.