Therapeutic potential of traditional Chinese medicine and mechanisms for the treatment of type 2 diabetes mellitus

Diabetes, a chronic metabolic non-communicable disease, has become prevalent worldwide. Its prevalence is increasing at an alarming rate, and the affected population is becoming increasingly younger, posing a serious threat to both individual health and social well-being. Notably, type 2 diabetes mellitus (T2DM) accounts for more than 90% of all diabetes cases, a statistic that underscores its dominant position in the disease burden. Despite substantial progress in the field of diabetes treatment, existing diabetes medications still fail to fully address the complex and pressing clinical needs of patients. Therefore, the development of new therapeutic drugs for T2DM is of crucial significance. Traditional Chinese medicine (TCM) has shown significant potential in alleviating the symptoms of T2DM and improving patients' quality of life, providing an effective complementary approach to conventional treatments. This study systematically clarifies and reviews the pathogenesis of T2DM from multiple dimensions, including inflammation, oxidative stress, ferroptosis, pyroptosis, necroptosis, autophagy, and gut microbiota. It also examines and summarizes TCM compound formulations and their main active ingredients that can improve the disease, and elucidates the disease-improving effects of these TCM ingredients targeting the aforementioned mechanisms. Studies have shown that TCM plays an important role in improving T2DM by targeting key mechanisms such as insulin resistance, β-cell damage, and glucose-lipid metabolism disorders. This not only provides valuable ideas and reference basis for researchers in endocrine basic research, pharmacologists, and clinicians to develop TCM with low toxicity and side effects but also opens up new research directions for the treatment of T2DM and lays a theoretical foundation for new drug development.