Back ground: Diabetes Mellitus in pediatric population presents unique challenges in managing glycemic control and preventing long term complications. Aim: This systematic review aims to explore the role of physical therapy in managing pediatric Diabetes Mellitus (DM), focusing on glycemic control, cardiovascular health, and psychological well-being. Methods: A narrative systematic review was conducted, analyzing data from studies involving structured physical activity interventions, such as aerobic and resistance training, in children with Type 1 DM . Results: Regular exercise was found to have significant benefits on blood glucose regulation, insulin sensitivity, cardiovascular health, and psychological well-being. Despite these advantages, barriers such as fear of hypoglycemia and lack of provider awareness hinder optimal implementation. Conclusion: Physical therapy plays a pivotal role in managing pediatric DM, and individualized exercise programs, continuous glucose monitoring, and greater education for healthcare providers and families are essential. Physiotherapists can design targeted interventions to improve functional abilities, prevent complications, and foster healthy development, ultimately empowering young patients to manage their condition effectively and live healthier lives.