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Type 2 diabetes mellitus (T2DM) is a chronic, progressive metabolic disease characterized by chronic hyperglycemia. Although its main physiological abnormalities are insulin resistance and impaired insulin secretion, the specific underlying determinants of these metabolic defects remain uncertain.
There are complex interactions between genetic, epigenetic, environmental and behavioral factors that contribute to the development of diabetes. Non-pharmacological and pharmacological interventions have been used for diabetic management. Over the past few years, research has started to focus on the use of novel adjuvant drugs as antioxidants and anti-inflammatory drugs for better management, as it was revealed that both oxidative stress and inflammation play a critical role in the disease pathogenesis.
Thus, the development of antidiabetic drugs that can reverse insulin resistance is a potential therapeutic target. Although antidiabetic drugs may be effective in improving glycemic control, they do not appear to be effective in entirely preventing the progression of pancreatic ß-cells damage mediated by chronic hyperglycemia-induced decline in intracellular antioxidants. Therefore, antioxidant and anti-inflammatory therapy should be considered as an adjunct to the commonly used oral antidiabetics

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Chapter Management of diabetes mellitus:
I- Non-pharmacological management of diabetes
Lifestyle modifications are the cornerstone of management of diabetes mellitus and include the prescription of a healthy diet, regular exercise, management of stress and avoidance of tobacco (150).
1-Diet:
The aims of dietary management are to achieve and maintain ideal body weight, euglycemia and desirable lipid profile, prevent and postpone complications related to diabetes and provide optimal nutrition during pregnancy, lactation, growth, old age and associated conditions, such as hypertension and catabolic illnesses (151). However, there is no single description for diet composition that can achieve these goals in all patients. Thus, the dietary recommendations should be individualized according to the person s ethnicity, cultural and family background, personal preferences and associated co-morbid conditions(150). Diet, that contains 60% carbohydrates, high dietary fiber, low to moderate dietary fat and moderate high biological value proteins as well as vitamins and minerals; especially chromium, vitamin E and C, is considered proper for management of diabetic patients (152).
2- Physical activity:
Exercise program should be individualized according to patient s capacity and disabilities. Diabetic patient must wear appropriate footwear. It should also be noted that poorly controlled patients may develop hyperglycemia during exercise, whereas patients treated with insulin and insulin secretagogues could develop hypoglycemia (153).
The best form of exercise recommended to diabetic is a stepwise increase of aerobic exercises. There are several benefits from a regular exercise schedule. These include reduction of hypertension and weight, increase in bone density, improvement in insulin sensitivity, cardiovascular function and lipid profile (reduces serum triglycerides and increases HDL-C), as well as improvement in the sense of physical and mental well-being and the overall quality of life (152).
3- Stress management:
Diagnosis of diabetes mellitus is a stressful situation in life of an individual and appropriate management; requires an approach that includes behavioural modification to develop positive attitude and healthy life style. A satisfactory treatment plan should include special attention to person with diabetes, quality of life, coping skills, optimal family support and a healthy workplace environment. Appropriate support and counseling is an essential component of the management at the time of diagnosis and throughout life(150).

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