Abstract / Summary
Background: Type 2 Diabetes Mellitus (T2DM) represents a global pandemic affecting approximately 537 million adults worldwide as of 2021, with projections indicating a rise to 784 million by 2045. Ayurveda, the ancient Indian system of medicine, has long described a condition analogous to T2DM — termed Madhumeha — and proposes a range of herbal, dietary, and lifestyle interventions. Despite growing interest in integrative approaches, a consolidated systematic assessment of clinical evidence remains limited. Objectives: This systematic review aims to evaluate the clinical efficacy of Ayurvedic interventions — including single herbal preparations, polyherbal formulations, Panchakarma procedures, and integrative lifestyle modifications — in the management of T2DM, with specific reference to glycaemic control, lipid profiles, and safety outcomes. Methods: A comprehensive literature search was conducted across PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), AYUSH Research Portal, and IndMED databases from January 2000 to August 2026. Randomised controlled trials (RCTs), pilot studies, and open-label clinical trials involving Ayurvedic interventions for T2DM were included. Primary outcomes included fasting blood glucose (FBG), postprandial blood glucose (PPBG), and glycated haemoglobin (HbA1c). Secondary outcomes included lipid profile, body mass index (BMI), and adverse effects. Results: Forty-two studies met inclusion criteria, encompassing 3,817 participants. Herbal preparations including Gymnema sylvestre, Momordica charantia, Pterocarpus marsupium, Trigonella foenum-graecum, and the polyherbal formulation Nishamalaki demonstrated statistically significant reductions in FBG (range: 18–42 mg/dL), PPBG (range: 24–68 mg/dL), and HbA1c (range: 0.5–1.8%). Panchakarma-based therapies, particularly Virechana, showed promising adjunctive benefits. No serious adverse events were reported in 89% of included trials. Conclusion: Ayurvedic interventions exhibit clinically meaningful efficacy in improving glycaemic parameters in T2DM patients. However, methodological heterogeneity, limited sample sizes, and short follow-up durations limit the strength of evidence. Standardised, large-scale, multicentre RCTs with rigorous CONSORT-Ayurveda reporting are urgently needed.