The gut microbiome plays a crucial role in metabolic regulation and has significant implications for diabetes development and management. Alterations in gut microbiota composition can influence insulin sensitivity, glucose metabolism, inflammation, and energy balance. Strategies targeting the microbiome, such as probiotics, prebiotics, dietary fiber, and synbiotics, are being explored to improve glycemic control and metabolic health. Personalized approaches that consider an individual’s microbial profile may optimize responses to nutrition, pharmacotherapy, and lifestyle interventions. Understanding the gut–diabetes connection provides new avenues for precision medicine, enabling healthcare providers to incorporate microbiome-targeted strategies into comprehensive diabetes care, enhance metabolic outcomes, and support long-term health.