Type 2 diabetes mellitus (T2DM) is a heterogeneous metabolic disease characterized by insulin resistance, progressive β-cell dysfunction, chronic hyperglycemia, oxidative stress, mitochondrial impairment, low-grade inflammation, dyslipidemia, endothelial dysfunction, and cumulative microvascular and macrovascular injury. Tocotrienols, unsaturated members of the vitamin E family, have attracted interest as multi-target bioactives capable of influencing several of these mechanisms simultaneously. This qualitative literature review critically evaluates evidence on palm-derived tocotrienol-rich fractions (TRF) and related tocotrienol formulations in T2DM, emphasizing glycemic control, insulin resistance, oxidative and inflammatory pathways, advanced glycation, endothelial biology, diabetic complications, and microRNA regulation. Human trials indicate potentially favorable effects on HbA1c and insulin resistance, while studies of diabetic kidney disease and peripheral neuropathy suggest organ-specific biological activity. Nevertheless, intervention heterogeneity is substantial, and the prominent trial demonstrating simultaneous glycemic, inflammatory, oxidative, and miRNA effects used an annatto-derived δ/γ-tocotrienol formulation rather than palm-derived TRF. Current evidence therefore supports biological plausibility rather than definitive disease modification. Future development requires standardized botanical provenance and isoform composition, pharmacokinetic verification, longer multicenter trials, contemporary cardiorenal background therapy, continuous glucose monitoring, complication-specific endpoints, and integration of metabolomics, lipidomics, epigenomics, and miRNA profiling. Tocotrienols are best positioned as investigational adjunctive nutraceuticals within precision metabolic care rather than alternatives to established diabetes therapies.