Data on urban and rural diabetes prevalence ratios show a significantly lower presence of diabetes in rural areas. Several bioactive compounds of plant origin are known to exert anti-diabetic properties. Interestingly, most of them naturally occur in different plants present in mountainous areas and are linked to traditions of herbal use. This review will aim to evaluate the last 10 years of evidence-based data on the potential anti-diabetic properties of 9 plants used in the Piedmont Alps (North-Western Italy) and identified through an ethnobotanical approach, based on the Occitan language minority of the Cuneo province (<i>Sambucus nigra</i> L., <i>Achillea millefolium</i> L., <i>Cornus mas</i> L., <i>Vaccinium myrtillus</i> L<i>., Fragaria vesca</i> L., <i>Rosa canina</i> L., <i>Rubus idaeus</i> L., <i>Rubus fruticosus/ulmifolius</i> L., <i>Urtica dioica</i> L.), where there is a long history of herbal remedies. The mechanism underlying the anti-hyperglycemic effects and the clinical evidence available are discussed. Overall, this review points to the possible use of these plants as preventive or add-on therapy in treating diabetes. However, studies of a single variety grown in the geographical area, with strict standardization and titration of all the active ingredients, are warranted before applying the WHO strategy 2014-2023. This review will aim to evaluate the last 10 years of evidence-based data on the potential anti-diabetic properties of 9 plants used in the Piedmont Alps (North-Western Italy) and identified through an ethnobotanical approach, based on the Occitan language minority of the Cuneo province ( Sambucus nigra L., Achillea millefolium L., Cornus mas L., Vaccinium myrtillus L., Fragaria vesca L., Rosa canina L., Rubus idaeus L., Rubus fruticosus/ulmifolius L., Urtica dioica L.), where there is a long history of herbal remedies. The mechanism underlying the anti-hyperglycemic effects and the clinical evidence available are discussed. The Piedmont Alps in Cuneo province show a peculiar heritage, as they belong to the Occitan-speaking valleys of Piedmont, a language minority of Alpine communities living 750 m above sea level (msl), with a solid herbal use tradition and agrarian economy tradition, beginning to be lost after the Second World War but recovering in the last decades [ 22 ], with the rediscovery of local traditions in favor of a return to agriculture flanked by tourism development. In the past years, the traditional knowledge of the plants of the Piedmont Alps was investigated through an ethnobotanical approach based on the concept of language and ethnic minority groups. In the more general attempt to relocate wild alpine plants as functional foods (foods that have beneficial effects on one or more functions beyond their nutritional properties [ 25 ]) based on traditional knowledge, this review aims to analyze the spontaneous (not exclusive) presence of plants in the Piedmont Alps (Italy) used by the Occitan language minority in the Cuneo province, for which the literature showed in vitro and in vivo anti-diabetic properties and/or are subject to ongoing clinical evaluation for pre-diabetes and diabetes ( Table 1 ). The review is structured in four sections: the first identifies and describes the selected plants in ethnobotanical terms; the second describes the main active ingredients with presumed anti-diabetic activity; the third, divided into sub-sections by single plant, provides a description of the experimental studies published in the 2011–2021-time frame; the fourth reports the results obtained from the most recent clinical studies. 2. Plants from the Occitan Valleys of the Piedmont Alps and Their Traditional Use Plants reported in Table 1 are all well known to the Piedmont Alpine Communities and their different local folk uses, far beyond their nutritional properties, are described below. Their relevance relates to their direct effect on signaling pathways involved in glucose homeostasis. Table 2 Plants used in the Occitan valleys of the Piedmont Alps: potential direct anti-diabetic mechanisms (experimental evidence between 2011 and 2021). Plant Part of the Plant Tested Mechanisms (Experimental Evidence) References Formulation Identified Active Ingredients Urtica dioica L. Hydroxyl and methoxyl groups can be attached to the core anthocyanin in different numbers and positions. These compounds are cyanidin, delphinidin, malvidin, pelargonidin, peonidin and petunidin. The primary sources of anthocyanins, apart from vegetables such as red cabbage and radish, are dark fruits such as blackberry, blueberry, cranberries, black and red currants, red grapes and raspberries. Accordingly, plants rich in anthocyanins, bilberry, blackberry and raspberry. are collected in natural environments in the They induced an increase of GSH and thio-barbituric acid reactive substances (TBARS), a decrease in protein carbonyl groups and advanced oxidation protein product levels, all markers of oxidative stress and subsequent damage to proteins [ 135 ]. The loganic acid extract, in particular, increases the GSH content, GPx and glutathione reductase in leukocytes, thus reducing ROS production [ 136 ]. 5. The Anti-Diabetic Effects of Plants from the Occitan Valleys of the Piedmont Alps: Clinical Evidence of Efficacy The clinical studies demonstrating the anti-diabetic efficacy of Alpine plants are scant and sparse. As expected, the Alpine extracts were tested in T2DM patients as supplements. Another randomized, double-blind, cross-over study involving 30 obese subjects with normal or impaired glucose tolerance, showed that a daily intake of a rosehip powder drink over 6 weeks, compared with a control drink, did not induce significative changes in glucose tolerance, plasma levels of HDL cholesterol, triglycerides, incretins and markers of inflammation. However, the authors observed a significant systolic blood pressure and LDL/HDL ratio reduction in the treatment group.