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This review highlights the promising role of MXenes and their composites in diabetes management, emphasizing their dual utility in diagnostics and therapeutics. MXenes' exceptional electrical conductivity, hydrophilicity, mechanical robustness, and tunable surface chemistry facilitate the design of sensitive and selective biosensors for real-time and non-invasive monitoring of key diabetes biomarkers like glucose and acetone. Therapeutically, MXene-based materials enhance healing of diabetic complications such as foot ulcers by modulating inflammation, scavenging reactive oxygen species, promoting angiogenesis, and supporting tissue regeneration <i>via</i> multifunctional hydrogels, patches, and scaffolds. Despite these advances, challenges remain including environmentally harmful synthesis methods, limited scalability, oxidation-induced instability under physiological conditions, and insufficient biocompatibility data. Future efforts are directed toward developing greener and scalable synthesis routes, improving MXene stability through surface modifications, and integrating MXenes with cutting-edge technologies such as wearable devices, 3D bioprinting, and bioelectronics. Additionally, the review uniquely explores the incorporation of artificial intelligence and machine learning techniques to enable personalized and adaptive diabetes management. By providing a comprehensive synthesis of recent developments, current limitations, and innovative future directions, this review offers novel insights aimed at accelerating the clinical translation of MXene-based platforms to significantly enhance diabetes diagnosis and treatment.