Background  
Many Ayurvedic medicines (traditional Indian medicine) have the potential for managing type 2 diabetes mellitus (T2DM), with previous systematic reviews demonstrating effectiveness and safety for specific Ayurvedic medicines. However, many of the reviews need updating and none provide a comprehensive summary of all Ayurvedic medicines.

Aim  
The aim of the systematic review was to evaluate and synthesize evidence on the effectiveness and safety of Ayurvedic medicines for managing T2DM, to inform the development of a clinical guideline for managing T2DM by Ayurvedic practitioners.

Method  
The JBI systematic review methodology was followed. Published and unpublished RCTs assessing the effectiveness and safety of Ayurvedic medicines for managing T2DM in adults were included. A comprehensive search of sources (including 18 electronic databases) from inception to 16 January 2021 was made. No language restrictions were applied. Data synthesis was conducted using narrative synthesis and random effects meta-analyses, where appropriate. Pooled Results are reported as mean differences (MD) with 95% confidence intervals (CI).

Results  
Out of 32,519 records identified from the searches, 219 articles were included in the systematic review representing 199 RCTs (21,191 participants) of 98 Ayurvedic medicines. Overall, in the studies reviewed the methodology was not adequately reported, resulting in poorer methodological quality scoring. Glycated hemoglobin (HbA1c) was significantly reduced using Aegle marmelos (MD -1.6%; 95% CI -3 to -0.3), Boswellia serrata (-0.5; -0.7 to -0.4), Gynostemma pentaphyllum (-1; -1.5 to -0.6), Momordica charantia (-0.3; -0.4 to -0.1), Nigella sativa (-0.4; -0.6 to -0.1), Plantago ovata (-0.9; -1.4 to -0.3), Tinospora cordifolia (-0.5; -0.6 to -0.5), Trigonella foenum-graecum (-0.6; -0.9 to -0.4), and Urtica dioica (-1.3; -2.4 to -0.2) compared to control. Similarly, fasting blood glucose (FBG) was significantly reduced by 4 to 56 mg/dL for a range of Ayurvedic medicines, with the largest effects seen for Aegle marmelos, Plantago ovata , and Gynostemma pentaphyllum . Very few studies assessed the health-related quality of life (HRQoL). Adverse events were not reported in many studies, and if reported, these were mostly none to mild and predominately related to the gastrointestinal tract.

Discussion  
A range of Ayurvedic medicines are effective at improving the blood glucose of T2DM patients. However, further high quality RCTs are needed especially to assess their effects on HRQoL and adverse events. This evidence base will be used to develop a clinical guideline for managing T2DM by Ayurvedic practitioners.



Effectiveness and safety of Ayurvedic medicines in type 2 diabetes management: a systematic review and meta-analysis