Background <p>Diabetes mellitus represents one of the most urgent global health challenges of the twenty-first century, with its prevalence continuing to rise across both developed and developing regions. Driven by the combined effects of genetic susceptibility, environmental exposures, and lifestyle factors, diabetes encompasses a complex interplay of insulin resistance, β-cell dysfunction, inflammation, oxidative stress, and metabolic dysregulation. In parallel with advances in molecular and pharmacological research, artificial intelligence (AI)–enabled digital health technologies have emerged as potential tools to support diabetes screening, monitoring, and clinical decision-making. However, the strength of evidence and degree of clinical validation for these technologies vary substantially.</p> Objective <p>This narrative review synthesizes recent advances in diabetes pathophysiology, diagnostic approaches, pharmacological therapies, and AI-enabled digital interventions, with a focus on distinguishing clinically validated applications from emerging technologies and assessing their relevance for Real-World implementation, including in resource-constrained settings.</p> Methods <p>A comprehensive narrative review of peer-reviewed literature, clinical guidelines, and global health reports published between 2015 and 2025 was conducted using PubMed, Scopus, World Health Organization, and International Diabetes Federation sources.</p> <p>Evidence relating to molecular mechanisms, diagnostic criteria, therapeutic strategies, and AI-supported screening, monitoring, and decision-support systems was qualitatively synthesized.</p> Results <p>AI and machine learning applications in diabetes care are most established in glucose monitoring, insulin delivery, and complication screening. Real-world studies and selected clinical trials of continuous glucose monitoring–based predictive algorithms and hybrid closed-loop systems demonstrate modest but clinically relevant improvements in time-in-range and reductions in hypoglycaemia, primarily in high-income settings. AI-assisted retinal image analysis shows high diagnostic accuracy for diabetic retinopathy screening, while risk prediction and treatment personalization models for type 2 diabetes remain largely investigational. Molecular studies reveal critical roles of NF-κB signaling, ER stress, mitochondrial dysfunction, and β-cell apoptosis in diabetes pathogenesis, while epigenetic and microbiome research identifies novel therapeutic targets. Pharmacological innovations provide complementary therapeutic advances that may be augmented by data-driven clinical decision support, although integration remains uneven.</p> Conclusion <p>AI-enabled technologies have demonstrated measurable benefits in selected domains of diabetes monitoring and complication screening, while broader applications in risk prediction and personalized therapy require further validation. Integrating digital tools with established pharmacological and lifestyle interventions may support a gradual transition toward more proactive diabetes care, provided that issues related to evidence quality, algorithm transparency, data governance, and equitable access—particularly in LMICs—are addressed. However, ethical governance, algorithm transparency, and equitable access remain essential for large-scale adoption. Future progress will depend on aligning molecular research, clinical trials, digital innovation, and public health policy to ensure responsible and scalable implementation.</p>