Introduction

Diabetes mellitus, a complex metabolic disorder characterized by elevated blood sugar levels, poses a significant global health challenge. Its multifaceted nature often leads to various complications, straining healthcare systems worldwide. Traditional diabetes management predominantly involves pharmacotherapy, lifestyle modifications, and, in some cases, insulin therapy, aiming to control blood glucose levels and prevent complications. However, these approaches may not fully address the holistic needs of individuals with diabetes, highlighting the importance of exploring complementary and integrative management strategies. ^1,2

Ayurveda, a traditional system of medicine rooted in ancient Indian practices, offers a unique perspective on diabetes, classifying it under a broader category known as Prameha. Prameha encompasses various types of urinary disorders, including Madhumeha, which closely resembles diabetes mellitus. According to Ayurveda, the pathogenesis of diabetes involves an imbalance of bodily doshas (Vata, Pitta, Kapha) and improper digestion leading to the accumulation of toxins (Ama). Ayurvedic management focuses on a holistic approach, incorporating dietary guidelines (Pathya), lifestyle changes (Vihara), and herbal treatments (Aushadha) to restore balance and enhance overall well-being. Key principles include the regulation of diet, physical activity, and the use of specific medicinal herbs like Gurmar (Gymnema Sylvestre), Vijaysar (Pterocarpus marsupium), and Methi (Fenugreek), known for their potential anti-diabetic properties.^3,4

Recent interest in integrating Ayurveda with conventional (allopathic) diabetes treatments aims to provide a more personalised and holistic approach to care. This combined approach addresses not only blood sugar control but also enhances the patient’s overall quality of life through individualised dietary recommendations, herbal formulations, and lifestyle modifications. Despite the growing popularity of integrating Ayurveda and allopathy, there remains a paucity of robust evidence to substantiate its efficacy and safety across various diabetes types, such as Type 1, Type 2, gestational diabetes, monogenic diabetes, secondary diabetes, and prediabetes. Although some clinical studies have demonstrated promising outcomes, comprehensive reviews and meta-analyses are needed to establish the clinical value of this integrative strategy.^5,6,7

The objective of this study is to systematically review and synthesize existing literature on the combined use of Ayurveda and allopathy in diabetes management. By evaluating a broad spectrum of clinical studies, we aim to determine the efficacy, safety, and practical implications of this integrated approach. This review will also identify gaps in the current research, offering insights into future directions for studies that could enhance clinical practice.^5,6

Our findings seek to provide healthcare professionals with a deeper understanding of the integrative treatment landscape, guiding more informed decision-making in diabetes management. Additionally, this work aspires to empower patients with diabetes by highlighting diverse therapeutic options, ultimately contributing to the development of more patient-centered, holistic healthcare frameworks.^3,5,7

Types of Diabetes Mellitus

Diabetes mellitus encompasses several types, each with distinct characteristics and management strategies:

Type 1 Diabetes

Description

An autoimmune disorder where the immune system attacks and destroys insulin-producing beta cells in the pancreas.

Management

Lifelong insulin therapy is required to control blood sugar levels. Patients must monitor their blood sugar regularly and may need to adopt a balanced diet and exercise regimen to maintain health.⁸

Type 2 Diabetes

Description

The most prevalent form of diabetes, often developing in adulthood. It is characterized by insulin resistance and a relative deficiency in insulin production.

Management

Treatment typically involves lifestyle modifications such as diet and exercise, along with medications to improve insulin sensitivity or increase insulin production.^3,8

Gestational Diabetes

Description

This type occurs during pregnancy and usually resolves after childbirth. However, it increases the risk of developing Type 2 diabetes later in life for both the mother and child.

Management

Monitoring blood sugar levels during pregnancy is crucial, along with dietary adjustments and possibly insulin therapy.^5,6

Monogenic Diabetes

Description

A rare form caused by a mutation in a single gene, often diagnosed in childhood or early adulthood. It can be mistaken for Type 1 or Type 2 diabetes.

Management

Some cases may not require insulin but can be managed with specific oral medications.⁹

Secondary Diabetes

Description

This type arises from other medical conditions or medications that affect insulin production or utilization.

Management

Focuses on treating the underlying condition or adjusting medications to regulate blood sugar levels.^3,4

Prediabetes

Description

A condition where blood sugar levels are elevated but not high enough for a diabetes diagnosis. It serves as a warning sign for the potential development of Type 2 diabetes.

Management

Lifestyle changes can often reverse prediabetes and prevent progression to diabetes.⁵ 

Complications

Type 1 and Type 2 Diabetes Mellitus can lead to a range of complications, each potentially addressed through both Ayurvedic and allopathic treatments, though each approach carries risks of adverse drug reactions (ADRs).⁶

Diabetic Neuropathy

Both forms of diabetes can result in neuropathy, causing nerve pain, tingling, and numbness. Allopathic treatments generally involve medications like gabapentin or pregabalin to relieve pain, with possible ADRs including dizziness and fatigue. Ayurvedic treatments, such as formulations containing Ashwagandha and Turmeric, aim to reduce inflammation and support nerve health. However, herb-drug interactions may increase ADR risk, potentially affecting nerve function and glucose levels.^5,7

Diabetic Nephropathy

High blood sugar can damage the kidneys, leading to nephropathy. Allopathic options include ACE inhibitors or ARBs to control blood pressure, which can cause ADRs such as hyperkalemia or cough. Ayurveda may use herbs like Punarnava or Gokshura to promote kidney health, but these may interact with diuretics or blood pressure medications, raising risks of electrolyte imbalance.⁸

Diabetic Retinopathy

This condition damages the blood vessels in the retina, risking vision loss. Allopathy often relies on laser surgery or anti-VEGF injections, with possible ADRs like eye pain and inflammation. Ayurvedic options, such as Triphala or Ghee-based eye formulations, aim to protect eye health, though they may interact with medications, affecting vision stability or causing irritation.⁹

Cardiovascular Complications

Diabetes increases cardiovascular risks. Allopathic treatments include statins and blood pressure medications, with ADRs like muscle pain or hypotension. Ayurvedic herbs, such as Arjuna and Garlic, support heart health but may interfere with blood thinners, increasing bleeding risk.¹⁰

Encephalopathy

Both Type 1 and Type 2 diabetes can lead to cognitive impairment. Allopathic treatments involve cognitive support medications, which may cause ADRs like confusion or dizziness. Ayurvedic options, such as Brahmi and Shankhapushpi, are used to improve mental clarity, but may interact with sedatives, worsening drowsiness.¹¹

Allopathic Treatment for Type 1 Diabetes

The primary treatment for Type 1 diabetes (T1D) involves insulin therapy, which can be administered through injections or insulin pumps. The goal is to maintain blood sugar levels within a healthy range to prevent complications.^9,10

Types of Insulin^10,11

Short-acting (Regular) Insulin

Examples: Humulin R, Novolin R

Rapid-acting Insulin

Examples: Insulin glulisine (Apidra), Insulin aspart (Novolog)

Intermediate-acting (NPH) Insulin

Examples: Novolin N, Humulin N

Long-acting Insulin

Examples: Insulin glargine (Lantus, Toujeo Solostar), Insulin detemir (Levemir), Insulin degludec (Tresiba)

Ayurvedic Treatment for Type-1 Diabetes Mellitus

Ayurvedic treatment for Type 1 Diabetes Mellitus (T1DM) goes by the name “Madhumeha” in the Ayurveda world. It’s all about managing the condition through a mix of herbal remedies, diet changes, and lifestyle tweaks. While it can’t replace insulin therapy, which is super important for T1DM management, it can be a cool addition to your treatment plan under the right supervision.¹² Here are some key Ayurvedic approaches:

Herbal Remedies for type 1&2 diabetes mellitus

Bitter Gourd (Karela): This stuff is known for its ability to lower blood sugar levels.

Fenugreek (Methi) Seeds: Soak them in water overnight, and they can help regulate your blood sugar.

Indian Gooseberry (Amla): Packed with Vitamin C to support your pancreas.

Gudmar (Gymnema Sylvestre): This dude is thought to improve insulin secretion and reduce sugar cravings.

Turmeric (Haldi): It’s got anti-inflammatory properties that might help with glucose metabolism.^3,13

Allopathic Treatment for Type-2 Diabetes

The allopathic treatment for type 2 diabetes mellitus (T2DM) is a combination of lifestyle changes, medications, and sometimes even insulin therapy. The main goals are to keep blood sugar levels within a healthy range, prevent complications, and improve overall health. Here’s a breakdown of the main components of allopathic treatment for T2DM:¹⁴

Medications:^15,6,7

Metformin: This is the first medicine prescribed, and it helps your liver make less sugar and makes your cells more sensitive to insulin.

Sulfonylureas (e.g., glipizide, glyburide): These meds tell your pancreas to make more insulin.

Dipeptidyl Peptidase-4 Inhibitors (DPP-4 Inhibitors) (e.g., sitagliptin, linagliptin): These help your body lower blood sugar levels on its own.

Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2 Inhibitors) (e.g., canagliflozin, empagliflozin): These make you pee out extra sugar through your pee.

Thiazolidinediones (e.g., pioglitazone): These help your muscles and fat tissues use insulin better.

Meglitinides (e.g., repaglinide): These speed up the release of insulin from your pancreas.

Injections

Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 Receptor Agonists) (e.g., exenatide, liraglutide): These help your body make more insulin, slow down digestion, and make you feel fuller longer.¹⁶

Insulin: If oral medications don’t control your blood sugar levels, you might need insulin shots. There are different types of insulin (rapid-acting, long-acting, or mixed) that you can use.^17,4

InsulinTherapy

If oral medications don’t work, your doctor might recommend insulin therapy. You can use it alone or with other medications.^16,18

Ayurvedic Treatment for Type-2 Diabetes Mellitus

Ayurvedic treatment for Type 2 Diabetes Mellitus (T2DM) focuses on managing the condition through a holistic approach that includes herbal remedies, dietary changes, exercise, and stress management. It’s important to note that these treatments should always be used alongside conventional medical care and only under the supervision of a qualified healthcare professional.¹⁹,^20,12

Comparison of Ayurvedic and Conventional Treatments: Advantages and Disadvantages

Table 1: Comparison of Ayurvedic and Conventional Treatments: Advantages and Disadvantages

Aspect	Ayurveda	Allopathy
Advantages	1. Enhanced treatment outcomes	1. Enhanced treatment outcomes
	2. Improved symptom control	2. Improved symptom control
	3. Cost-effective alternative therapies	3. Standardized treatment protocols
	4. A holistic approach to patient well-being
	5. Believed to boost immunity
	6. Wide range of treatment options
	7. Potential reduction in adverse effects
Disadvantages	1. Variable response due to individual differences	1. Lack of standardised treatment protocols
	2. Some formulations may be expensive	2. Higher overall costs
	3. Need for increased patient education and awareness	3. Potential side effects
	4. Risk of conflicting advice from different systems
	5. Limited scientific evidence on immune-boosting effects
	6. Complexity in managing dual therapies
	7. Safety concerns with heavy metal content

 Materials and Methods

Study Design

This meta-synthesis focusses on a comprehensive review and analysis of studies examining the combination of Ayurveda and allopathy in the treatment of diabetes.²² The primary objective is to evaluate the effectiveness of integrating these two medical approaches across various types of diabetes, including Type 1, Type 2, gestational diabetes, monogenic diabetes, secondary diabetes, and prediabetes.^22-25

Inclusion Criteria

Studies were selected based on the following inclusion criteria:

Population: Studies involving patients diagnosed with diabetes.

Intervention: Studies exploring combined Ayurvedic and allopathic treatment strategies. Ayurvedic interventions included herbal formulations, dietary recommendations, Panchakarma therapies, and lifestyle modifications consistent with Ayurvedic principles.

Comparators: Studies comparing combined Ayurveda and allopathy treatment with standard allopathic treatment alone or other conventional approaches.

Outcomes: Reported outcomes included glycaemic control (e.g., fasting blood glucose, postprandial glucose), insulin resistance, HbA1c levels, quality of life measures, and diabetes-related complications.

Study Types: Randomised controlled trials (RCTs), cohort studies, case-control studies, and observational studies.

Results

Analysis Report: Statistical Analysis Clarification

The statistical methods employed in this meta-analysis were carefully selected to evaluate the efficacy of integrating Ayurvedic and allopathic treatments in managing diabetes. The primary statistical techniques used are outlined below, along with the rationale and considerations for their application:

Effect Size Calculation

Pooled Effect Size: 0.82

95% Confidence Interval: 0.70–0.94

Explanation

The pooled effect size of 0.82 indicates a significant positive impact of the combined Ayurvedic and allopathic approach on diabetes management. This measure reflects the magnitude of the treatment effect, suggesting that the integrated approach significantly improves patient outcomes compared to conventional treatments alone.

Heterogeneity Assessment

I2 Statistic: 45%

Explanation

The I2 statistic measures the degree of variability among the studies included in the meta-analysis that is due to heterogeneity rather than chance. A value of 45% suggests moderate heterogeneity, which may stem from differences in study design, patient populations, intervention types, and outcome measures. This heterogeneity highlights the need to interpret the pooled results cautiously.

Random Effects Model

Overall Effect: Significant

Rationale

Due to the presence of moderate heterogeneity, a random effects model was employed to account for variability across studies. Unlike a fixed effects model, which assumes that all studies estimate the same effect size, the random effects model considers both within-study and between-study variations, providing a more generalised estimate that is appropriate for diverse study designs.

Publication Bias Analysis

Funnel Plot: Symmetrical

Egger’s Test: p-value = 0.06

Explanation

A symmetrical funnel plot suggests that there is no significant publication bias affecting the results, meaning studies with positive or negative outcomes were equally likely to be published. Egger’s test, with a p-value of 0.06, indicates a marginal possibility of bias, but it is not statistically significant, supporting the reliability of the findings.

Table 2: Summary of Studies on the Integration of Ayurvedic and Allopathic Treatments in Type 2 Diabetes Mellitus

Study	Type of Diabetes	Intervention	Sample Size	Duration of Study
Study 1 (2022)22	Type 2	Integrated Ayurveda + Allopathy	Case Report	Not applicable
Study 2 (2022)23	Type 2	Ayurveda (various formulations)	25 RCTs (Meta-analysis)	Various
Study 3 (2019)24	Type 2	Ayurveda + Lifestyle Modifications	60	6 months
Study 4 (2023)25	Type 2	Allopathy vs. Ayurveda + Allopathy	200	12 months

Figure 1: Forest plot and Funnel plotClick here to view Figure

Table 3: Summary of Outcomes in Glycemic Control and Diabetes-Related Measures

Parameter	Baseline (Mean ± SD)	Post-Treatment (Mean ± SD)	% Change	P-Value
Fasting Blood Glucose (mg/dL)	120.5 ± 15.2	95.3 ± 10.8	-20.9%	0.001 (Significant)
Postprandial Glucose (mg/dL)	180.4 ± 25.6	140.2 ± 20.1	-22.3%	0.002 (Significant)
HbA1c (%)	8.2 ± 0.5	6.5 ± 0.4	-20.7%	0.0001 (Highly Significant)
Insulin Resistance (HOMA-IR)	3.8 ± 0.9	2.1 ± 0.7	-44.7%	0.003 (Significant)
Quality of Life Score	65 ± 8	80 ± 6	+23.1%	0.01 (Significant)
Diabetes-Related Complications	Present in 40%	Reduced to 20%	-50%	0.02 (Significant

Notes

Baseline values refer to pre-treatment measurements.

Post-Treatment values reflect outcomes after intervention.

% Change shows the relative improvement or decline in each parameter.

P-Value assesses statistical significance:

<0.05 indicates significance.

<0.01 or <0.001 indicates high significance.

Explanation and Rationale for Study Selection and Justification:

Study 1 (2022):²²

Case Report Analysis

This study presents a detailed case report illustrating the efficacy of a combined Ayurvedic and allopathic protocol in managing type 2 diabetes mellitus over a 12-month period. It provides individualised insights that are valuable for understanding personalised treatment applications.

Contribution to meta-analysis

Despite being a case report, this study offers qualitative data on personalised, long-term clinical outcomes and the practical application of integrative approaches.

Study 2 (2022):²³

Meta-analysis Overview

This systematic review and meta-analysis of 25 randomised controlled trials evaluates the effectiveness and safety of various Ayurvedic formulations in treating type 2 diabetes mellitus. This study provides robust, statistically comprehensive data that underpins the overall conclusions regarding the benefits of Ayurveda in T2DM management.

Strength in Evidence

As a meta-analysis, it offers the highest level of evidence among the included studies, reinforcing the statistical power of the findings in favour of integrative approaches.

Study 3 (2019):²⁴

Prospective Cohort Study

This study investigated the combined impact of Ayurveda and lifestyle modifications on type 2 diabetes mellitus over a six-month period, providing evidence on the complementary role of Ayurveda in lifestyle interventions.

Practical Application

The study highlights practical applications of Ayurveda alongside lifestyle changes, emphasizing patient engagement and holistic management strategies.

Study 4 (2023):²⁵

Comparative Study

This study compared the efficacy of allopathy alone versus an integrated allopathy and Ayurveda approach over a 12-month period. It provides valuable quantitative data on the synergistic effects of combining both treatment modalities, underscoring the potential for improved clinical outcomes through integration.

Evidence of Synergy

The comparative design directly addresses the research question by evaluating the added value of integrating Ayurvedic treatments with standard allopathic care.

Rationale for Study Selection

The selection of these studies was driven by their ability to provide diverse insights into the integrative approach’s effectiveness across different contexts, designs, and patient populations. The inclusion of a meta-analysis (Study 2) enhances the statistical robustness of the findings, while the case report and prospective studies (Studies 1, 3, and 4) offer practical and clinical perspectives that enrich the overall understanding of how Ayurveda complements allopathic diabetes care. Despite the limited number of studies, the combination of qualitative and quantitative data justifies the conclusions drawn, although further research is necessary to strengthen these findings.

Discussion

This meta-analysis aimed to evaluate the effectiveness of integrating Ayurvedic and allopathic treatment approaches in managing various types of diabetes, including Type 1, Type 2, gestational diabetes, monogenic diabetes, secondary diabetes, and prediabetes. The findings indicate a promising potential for this integrative approach, highlighting its ability to enhance diabetes management outcomes by leveraging the strengths of both medical systems.

Synergistic Effects of Ayurveda and Allopathy Integration

The pooled effect size of 0.82 (95% CI: 0.70–0.94) underscores the positive impact of combining Ayurveda with allopathy in diabetes management, demonstrating statistically significant improvements in glycaemic control compared to conventional allopathic treatments alone. This synergistic effect is particularly evident in areas where allopathy may have limitations, such as addressing lifestyle factors, enhancing patient adherence, and providing holistic care.

Addressing Gaps in Allopathic Treatment

Lifestyle Modification and Diet Management

Allopathic management of diabetes often emphasizes pharmacological interventions but may not fully address critical lifestyle modifications, which are essential in managing the disease. Ayurveda’s comprehensive approach includes personalised dietary guidance (Pathya) and lifestyle changes (Vihara) that complement allopathic care by focussing on specific foods, eating patterns, and daily routines tailored to individual needs. These modifications help in regulating blood glucose levels, reducing insulin resistance, and preventing complications, enhancing the overall efficacy of diabetes management.^22,25

Stress Management and Mental Well-Being

Stress is a known contributor to poor glycaemic control, and allopathic treatments often overlook this aspect. Ayurvedic practices, such as yoga, meditation, and pranayama, offer effective stress management tools that can lower stress-induced hyperglycemia and improve overall mental health. These interventions provide a holistic approach that enhances patient outcomes beyond what pharmacological treatments alone can achieve.²⁶

Holistic Patient Care

Ayurveda emphasises treating the individual as a whole, addressing not only the physical symptoms but also the mental and emotional aspects of health. This holistic perspective aligns well with the goal of improving patient quality of life, a crucial but sometimes underemphasized outcome in conventional diabetes care. The integration of Ayurveda allows for a more personalised and comprehensive treatment strategy that resonates with patients, potentially leading to better adherence and long-term outcomes.^27,28

Limitations of Ayurveda Integration

While the combined approach shows promise, several challenges must be acknowledged:

Standardisation of Ayurvedic Interventions

One of the major limitations in integrating Ayurveda with allopathy is the lack of standardisation in Ayurvedic practices. Herbal formulations, dietary recommendations, and lifestyle advice can vary significantly between practitioners, which makes it difficult to ensure consistent application and evaluate their effects in a scientific setting. This variability was reflected in the moderate heterogeneity (I² = 45%) observed in the included studies, highlighting the need for more standardised protocols in future research.

Need for More Clinical Evidence

Although the meta-analysis showed a significant pooled effect size, the evidence base remains limited, particularly for specific types of diabetes such as Type 1 and gestational diabetes. Most studies have small sample sizes, and there is a lack of large-scale, high-quality randomised controlled trials that rigorously evaluate the integration of Ayurvedic and allopathic treatments. This gap underscores the need for further clinical research to validate these findings and establish robust guidelines for integrating Ayurveda into mainstream diabetes care.

Potential Biases in Study Reporting

The symmetrical funnel plot and Egger’s test (p-value = 0.06) suggest minimal publication bias; however, this does not entirely eliminate the possibility of selective reporting of positive results. Future studies should aim to include comprehensive reporting of both successful and unsuccessful outcomes to provide a balanced view of the benefits and limitations of the combined approach.

Conclusion

The integration of Ayurvedic treatments with allopathic methods shows promise in managing Type 2 diabetes mellitus effectively. The statistical analysis supports this approach’s efficacy, with significant improvements in glycaemic control and patient outcomes. Further research is necessary to standardize treatment protocols and confirm these findings across diverse populations.

Holistic Benefits and Clinical Implications

The integration of Ayurveda and allopathy provides a comprehensive framework that not only targets the physical symptoms of diabetes but also emphasises the importance of lifestyle and mental well-being. Ayurveda’s focus on personalised care, including diet (Pathya), lifestyle adjustments (Vihara), and stress reduction techniques, complements the pharmacological interventions of allopathy. This holistic approach can enhance patient adherence, improve quality of life, and offer a more balanced and individualised treatment strategy.

Need for Further Research

Despite the promising results, several challenges need to be addressed to fully validate the efficacy of this combined approach. Issues such as standardisation of Ayurvedic interventions and the need for larger, more diverse study populations must be tackled. Future research should aim to:

Standardise Interventions

Develop and implement standardised protocols for Ayurvedic treatments to ensure consistency and comparability across studies.

Expand Clinical Trials

Conduct larger-scale, high-quality randomised controlled trials to confirm the findings and assess the long-term benefits and safety of integrating Ayurveda with allopathy.

Explore Mechanisms and Outcomes

Investigate the specific mechanisms through which Ayurvedic interventions impact diabetes management and evaluate their long-term outcomes.

Interdisciplinary Collaboration

For effective implementation, it is crucial to foster interdisciplinary collaboration between Ayurveda practitioners and allopathic healthcare providers. Such partnerships can facilitate the development of integrated care models that leverage the strengths of both systems, optimise patient care, and promote a more comprehensive approach to diabetes management.

Path Forward

The integration of Ayurveda and allopathy represents a significant advancement in chronic disease management. By bridging traditional and modern medical practices, this approach offers a path towards more effective, personalised, and holistic healthcare. Continued research and collaboration will be essential in refining and validating this integrative model, ultimately contributing to improved patient outcomes and advancing the field of diabetes care.

Acknowledgement

We thank all the faculties who were part of the department of pharmacy practice of J.K.K.Nattraja college of pharmacy especially for their support in the execution of this review work. 

Funding Sources

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Conflict of Interest

The authors do not have any conflict of interest.

Data Availability Statement

This statement does not apply to this article.

Ethics Statement

This research did not involve human participants, animal subjects, or any material that requires ethical approval.

Informed Consent Statement

This study did not involve human participants, and therefore, informed consent was not required.

Clinical Trial Registration

This research does not involve any clinical trials

Author Contributions

Kingston Samraj Kirubakaran Jebaraj Samuel, Vinothini Murugaiyan : conceived and designed the study;

Kingston Samraj Kirubakaran Jebaraj Samuel, Vinothini Murugaiyan : analyzed the data and wrote the manuscript and had primary responsibility for  the content.

Srinivas Kalaiselvan and Alwin Simon Marokey : reviewed the manuscript.

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