Frontiers in Clinical Diabetes and Healthcare · Oct 31, 2026
Type 2 Diabetes Mellitus: A Narrative Review of Epidemiology, Pathophysiology, Clinical Management and Prevention
By Dr Sudhanshu Ashok Mahajan, Jayashree Sachin Gothankar, Pooja Sudarshan Sohil et al.
Introduction: Type 2 diabetes mellitus (T2DM) represents a major and increasing global health burden, with particularly important implications for low-and middle-income countries. Advances in understanding disease mechanisms and treatment have substantially changed diabetes care, yet important gaps remain in prevention, equitable access, and translation of evidence into routine practice. Methods: This narrative review was conducted using a structured, non-systematic literature search guided by the principles of the Scale for the Assessment of Narrative Review Articles (SANRA). PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, and Google Scholar were searched, together with authoritative guidelines and reports from organisations including the World Health Organization (WHO), International Diabetes Federation (IDF), American Diabetes Association (ADA), and Indian Council of Medical Research (ICMR). No lower publication-year limit was applied; the search was updated to 1 July 2026 and restricted to English-language publications. Study selection was undertaken by three authors. Priority was given to contemporary guidelines, systematic reviews and meta-analyses, landmark randomised controlled trials, major epidemiological studies, and primary policy documents, while seminal older studies were retained where relevant. Results: T2DM results from complex interactions among insulin resistance, progressive β-cell dysfunction, adiposity, metabolic abnormalities, and behavioural and environmental factors. Contemporary management has shifted from a predominantly glucose-centred approach towards integrated management of glycaemic, cardiovascular, kidney, and weight-related risks. Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists have expanded therapeutic options, while lifestyle modification remains fundamental to prevention and management. Evidence strength varies across interventions: guidelines and clinical trials support established pharmacological and preventive strategies, whereas evidence for nutraceuticals, digital-health interventions, some combination approaches, and community-based models is more heterogeneous or emerging. Implementation, adherence, affordability, access, and scalability remain major challenges, particularly in resource-constrained settings. Conclusion: Effective T2DM control requires integration of early detection, individualised pharmacological therapy, sustained lifestyle intervention, complication prevention, and population-level strategies. Clinical practice and public health programmes should prioritise evidence-based risk reduction while considering feasibility, equity, and access. Future research should focus on long-term comparative effectiveness, scalable prevention, equitable implementation of newer therapies, and rigorous evaluation of digital and community-based care models.