Exploring the Role of Ayurveda in Prediabetes Management: Insights from Experimental and Clinical Evidence

Introduction

Prediabetes, a precursor to Type 2 Diabetes (ICD 10- R73.03), is characterized by elevated blood glucose levels that are not yet high enough to be termed as diabetes.¹ This critical stage offers a window of opportunity for timely intervention to prevent or delay the onset of fully manifested diabetes, which affects approximately 10.3% of India's population.² With its asymptomatic nature and risk factors such as sedentary lifestyles, unhealthy diet habits, obesity, and genetic predisposition, prediabetes has become a significant public health concern globally, underscoring the need for early detection and effective preventive strategies.

The studies considered for the current review highlight that Ayurveda, with its focus on lifestyle modification and herbal or medicinal remedies, presents a promising approach for managing prediabetes. Studies have highlighted the efficacy of Ayurvedic treatments, such as Vamana Karma (therapeutic emesis), Darvyadi Kwatha, and polyherbal formulations like Nisha Amalaki, in improving glycaemic control, reducing insulin resistance, and enhancing overall health. These therapies target key markers, including fasting blood sugar (FBS), postprandial blood sugar (PPBS), and Glycated Hemoglobin (HbA1c) while addressing both physical and mental well-being. Such evidence supports Ayurveda's potential to provide comprehensive, effective interventions to manage and prevent the progression of prediabetes.

In this article, we present a narrative review of existing experimental and clinical studies on the role of Ayurveda in the management of prediabetes. This review explores how Ayurvedic interventions may help disrupt the cycle of metabolic dysfunction that characterizes prediabetes. The evidence also highlight the potential for integrating Ayurvedic practices into mainstream preventive care for diabetes. Through a synthesis of the available evidence, we aim to highlight the strengths and limitations of Ayurvedic approaches and underscore the need for further research to establish their role in preventing the progression from prediabetes to Type 2 diabetes mellitus. A comprehensive literature search was conducted to gather relevant studies on the role of Ayurveda in the management of prediabetes. The search was performed using the Medical Subject Headings (MeSH) terms “Ayurveda” and “Prediabetes,” linked by the Boolean operator “AND” to capture studies that specifically focus on the intersection of these two topics. The databases used for this search were Science Direct, PubMed, and EBSCO, which are widely recognized for their extensive coverage of peer-reviewed scientific articles.

The review process was restricted to articles published in English, a common universal language, so that the studies are better interpreted and compared. Articles published up to March 2024 were considered to provide up-to-date and relevant data. The initial search yielded 54 articles. However, after applying the inclusion and exclusion criteria, including relevance to Ayurveda based interventions, clinical trials, experimental studies, and research articles on prediabetes, a total of 8 peer reviewed articles were included in this review.

The selected studies represent a range of approaches within Ayurvedic medicine, focusing on both theoretical and clinical aspects of prediabetes management. They include randomized controlled trials (RCTs), observational studies, and experimental research on herbal formulations, detoxification therapies, and lifestyle modifications prescribed in Ayurveda. By compiling and reviewing these studies, the review aims to present a holistic understanding of how Ayurvedic practices can potentially contribute to addressing the growing burden of prediabetes and its progression to Type 2 Diabetes mellitus. The analysis of these studies will provide a comprehensive overview of the strengths, limitations, and prospects of integrating Ayurveda into preventive care for prediabetes.

Ayurveda Diagnostics and Preventive Strategies

Ayurveda-based questionnaire for identifying prediabetes features: A retrospective study

This study aimed to integrate Ayurvedic knowledge with modern clinical tools by developing a questionnaire to identify early signs of Prameha Purvarupa (the prediabetic stage) based on classical Ayurvedic texts. The questionnaire, with 22 features, was administered to 141 newly diagnosed diabetic patients to assess whether these signs were present before the onset of diabetes. By comparing diabetics and healthy individuals, the study found a significant difference in the occurrence of 11 key features, such as improper digestion, frequent urination, fatigue, sweet cravings, and lethargy, which align with Ayurveda’s early indicators of metabolic disturbances.

The results validated the Ayurvedic concept of Purvarupa by highlighting the presence of specific early symptoms in those who later develop diabetes. The study suggested that these findings could lead to the development of a risk calculator to predict the onset of diabetes in prediabetic individuals, facilitating early interventions through lifestyle changes or Ayurvedic therapies. Incorporating Ayurvedic diagnostics into routine clinical practice could enhance early detection and prevention, complementing modern medical approaches to diabetes management.³

The urgent need for effective diabetes prevention and control strategies

The article highlights the public health challenges posed by the global rise in diabetes, particularly Type 2, which tends to remain in long dormancy and often delays diagnosis until severe stages. Many individuals remain unaware of their pre-diabetic status due to the absence of apparent symptoms, resulting in missed opportunities for lifestyle changes that could prevent progression to diabetes. Increasing public awareness of this condition and encouraging early detection is essential for effective prevention. Ayurveda offers valuable insights for diabetes prevention through its focus on recognizing early signs of disease as part of Shad Kriyakala (the stage of the disease pathogenesis where specific interventions are to be executed), known as Prameha Purvarupa. A handy tool can be useful in utilizing Prameha Purvarupa to prevent the progression from prediabetes to fully manifested diabetes mellitus. In 2016, the Ministry of AYUSH, Government of India, dedicated National Ayurveda Day on the theme “Prevention and Control of Diabetes through Ayurveda”, under the “Mission Madhumeha” project. A comprehensive document on ‘National Protocol for Prevention and Control of Diabetes through Ayurveda (NPPCDA)’ was also launched to promote the use of Ayurveda for the prevention of diabetes, generating awareness about the strengths of Ayurveda in diabetes, educating people about self-help, improving the surveillance, and effective management of diabetes and its complications. This objective also led to the development of a Madhumeha Assessment Tool (MAT). In conclusion, early identification and intervention can halt or reverse the progression of pre-diabetes, reducing the risk of complications such as cardiovascular disease and kidney damage.⁴ The tool development process in Ayurveda is relatively underexplored and requires a systematic approach that follows a standard protocol.⁵

Ayurvedic Purification Procedures and Medicinal Interventions

Comparative effectiveness of Vamana Karma and Darvyadi Kwatha in prediabetes management

The study compared the effectiveness of two Ayurvedic treatments for managing prediabetes: Vamana Karma (therapeutic emesis) followed by Darvyadi Kwatha versus Darvyadi Kwatha combined with lifestyle modifications. Forty prediabetic participants were randomly assigned to two groups: Group A received Vamana (for about 15 days), followed by Darvyadi Kwatha at a dosage of 80 mL twice daily before food for 30 days; and Group B, received only Darvyadi Kwatha in the same dosage and duration, along with lifestyle advice. Primary outcomes measured included HbA1c, fasting blood sugar (FBS), and postprandial blood sugar (PPBS), along with secondary outcomes such as digestive strength, physical and mental well-being, and quality of life as assessed using the SF-36 health survey.

Both groups showed significant improvements in glycaemic control; however, Group A exhibited more pronounced reductions in HbA1c, FBS, and PPBS, along with better outcomes in digestion, physical strength, and mental health. Statistical analysis confirmed that Vamana, combined with Darvyadi Kwatha, offered superior outcomes compared to lifestyle changes alone, particularly in terms of HbA1c reduction and overall quality of life. The study concluded that Ayurvedic purification therapies like Vamana may serve as an effective treatment option for preventing the progression of prediabetes to diabetes.⁶

Polyherbal Formulations

Effects of Kal-1 on metabolic and immune responses in a mice model

The study delves into the efficacy of Kal-1, a polyherbal decoction composed of seven natural ingredients, namely heartwood of Pterocarpus marsupium, bark of Acacia catechu, fruit of Emblica officinalis, fruit of Terminalia chebula, fruit of Terminalia bellerica, rhizome of Curcuma longa and root of Plumbago indica. These ingredients are recognized for their roles in regulating blood sugar levels and mitigating inflammation, particularly in the context of obesity and metabolic disorders. Utilizing C57BL/6J mice as a model, the research was designed with two experimental groups. The first group was subjected to a high-fat, high-sucrose diet while receiving varying doses of Kal-1 (5, 20, and 75 μL) over 21 weeks. The second group followed the same dietary regimen but commenced treatment with Kal-1 only after the initial 21 weeks. This setup enabled a comprehensive evaluation of Kal-1's impact on various metabolic parameters, allowing researchers to assess both preventive and therapeutic potentials. The study's results were compelling, demonstrating significant improvements in key health indicators among the Kal-1-treated obese and diabetic mice. Specifically, there were notable decreases in body weight, fat pad volume, fasting blood glucose levels, and insulin concentrations. Furthermore, Kal-1 treatment led to alterations in both biochemical and immunological markers, reflecting its capacity to modulate immune responses. Notably, Kal-1 also affected pro- and anti-cytokine levels, underscoring its potential as an immunomodulatory agent in the context of diet-induced obesity and associated metabolic disorders. These findings not only reinforce the efficacy of Kal-1, but also highlight its promise as a therapeutic approach in managing obesity-related metabolic challenges.⁷

Efficacy and safety of Nisha-Amalaki capsules in prediabetes management: A six-month study

This prospective, single-blind, placebo-controlled, randomized clinical study evaluated the efficacy and safety of Nisha-Amalaki in capsule form, in preventing the progression of diabetes in prediabetic patients over a six-month period. The contents of the formulation used in the study were: Curcuma longa alcohol extract (28.1%), C. longa water extract (1.76%), C. longa oil (1.27%), Phosphatidylcholine (12.65%) (excipient for bioavailability enhancement), E. officinalis extract (40.41%) and E. officinalis juice powder (15.81%). This extract was standardized to contain total curcuminoids (<20%), gallic acid (<5%), and total tannins (<20%).

A total of 62 participants were randomized into two groups: one received 500 mg of Nisha-Amalaki twice daily, and the other a placebo. Key health indicators were monitored, including fasting blood sugar, HbA1c, insulin resistance (HOMA-IR), oxidative stress markers, and Ayurvedic symptoms. Out of 62 participants, 58 completed the study, with results showing significant improvements in metabolic health in those taking Nisha Amalaki. These improvements included reductions in blood sugar, BMI, and insulin resistance, as well as better oxidative stress markers and an enhanced quality of life.

The Nisha-Amalaki group also reported improvements in Ayurvedic symptoms such as fatigue and poor digestion, reflecting the formulation’s holistic benefits. Although the study lacked assessment of safety parameters, such as liver and renal function tests, no adverse effects were noted, indicating its safety. The study concluded that Nisha-Amalaki effectively enhances insulin sensitivity and may prevent the progression of prediabetes. These f indings highlight the potential of integrating Ayurvedic remedies, such as Nisha-Amalaki into modern diabetes prevention strategies, warranting further research and clinical application.⁸

Efficacy of polyherbal combination in diabetes prevention

This study evaluated the effectiveness of a polyherbal combination, known as polyherbal decoction for blood sugar control, alongside lifestyle modifications (LSM) in preventing diabetes among prediabetic individuals. The trial drug PDBT was a combination of five drugs that had previously been shown to have hypoglycaemic properties. The formulation contained aqueous extracts of the stem of Tinospora cordifolia (Thunb.) Miers, bark of Pterocarpus marsupium Roxburgh, leaves of Gymnema sylvestre R. Br., rhizome of Zingiber officinale Roscoe and fruit of Momordica charantia L  in equal proportions conducted as a double-blind, placebocontrolled, randomized trial involving 114 participants, the research revealed that only eight participants in the PDBT group developed diabetes compared to 15 in the placebo group, reflecting a significant 47% risk reduction. Additionally, improvements were observed in blood glucose levels, glycated hemoglobin (HbA1c), fasting insulin levels, and insulin resistance (HOMA IR), indicating the formulation's potential to enhance metabolic health. Importantly, no adverse effects were reported in the PDBT group, suggesting that the polyherbal combination is both effective and safe; however, the assessment of safety parameters, such as liver and renal function tests, was not conducted. The study concluded that PDBT, combined with lifestyle modifications, is more effective in preventing diabetes progression than a placebo with similar lifestyle interventions. These findings highlight the potential of integrating traditional Ayurvedic remedies into modern preventive healthcare strategies, offering holistic options for managing prediabetes.⁹

Validation and standardization of Madhuram- A polyherbal formulation in managing prediabetes

The study aimed to validate and standardize Madhuram, an Ayurvedic polyherbal formulation utilized as a health supplement for managing prediabetes. This formulation comprised six key antidiabetic herbs, each selected for their traditional efficacy and biochemical properties, namely, the dried whole plant of Phyllanthus amarus Schum. and Thonn., leaves and stems of T.cordifolia (Willd.) Miers ex Hook. F and Thoms, whole fruit of Eugenia jambolina Lam and E.officinalis Gaertn., Leaves of Gymnema sylvestre R.Br. Ex., flowers of Cassia auriculata Linn. To ensure the reliability and consistency of Madhuram, researchers employed High Performance Thin Layer Chromatography (HPTLC) to analyze and quantify specific bioactive markers known to contribute to its therapeutic effects. The study meticulously assessed the presence of key compounds, including phyllanthin, berberine, ellagic acid, gallic acid, gymnemic acid, and sennoside B, which are associated with glucose metabolism and insulin sensitivity. The results of the HPTLC analysis confirmed the presence of critical markers, including phyllanthin at 3.17 μg, berberine at 4.92 μg, gallic acid at 72 μg, ellagic acid at 66 μg, and gymnemic acid at 410 μg. Notably, sennoside B was not detected, indicating variations in component concentration that could influence the formulation's overall efficacy. This rigorous analysis not only validates the identity of the herbal components but also lays a solid foundation for standardizing Madhuram across different production batches. Such standardization is crucial for ensuring consistent quality and effectiveness when integrating Madhuram into conventional medical practices, thereby enhancing its acceptance and applicability in modern healthcare for the management of prediabetes.¹⁰

Dietary Considerations

Impact of curd and yogurt consumption on oxidative stress and inflammation in a prediabetic model

The study investigated the impact of fermentation periods of curd and yogurt on glycation, oxidative stress, and inflammation in prediabetic rats over a 45-day period. Rats were fed 1.5 g of curd twice daily, and key metabolic markers were monitored. The results showed that consuming 24-hour fermented curd and yogurt significantly increased Advanced Glycation End Products (AGEs) in the liver and kidney, along with heightened oxidative stress and inflammatory responses. Rats consuming 24 hour curd exhibited reduced antioxidant enzyme levels (SOD), increased oxidative damage (TBARS), and elevated pro-inflammatory cytokines such as IL-6 and TNF-α, indicating a shift towards a pro-inflammatory state, that contributes to insulin resistance and diabetes complications. Even 12-hour curd consumption led to AGE accumulation, although to a lesser degree.

The study found that 24-hour and 12-hour fermented curd could worsen metabolic health in prediabetic conditions, with more extended fermentation period posing a higher risk. The findings emphasize that curd and yogurt, while commonly consumed, may contribute to oxidative stress, protein glycation, and inflammation, all of which exacerbate prediabetic conditions. In Ayurveda, Dadhi is described as heavy, sour, and challenging to digest, which can increase Kapha dosha and be a potential contributor to the causation of Prameha. This underscores the need to carefully adopt dietary interventions, particularly concerning the fermentation period of dairy products, for individuals at risk of developing Type 2 diabetes.¹¹ Further studies on the timing of curd consumption may help clarify its contraindication at night, as per Ayurveda.

Discussion

Eight studies on managing prediabetes through Ayurvedic and traditional interventions present a comprehensive examination of alternative approaches to diabetes prevention, focusing on natural remedies and lifestyle modifications. These studies collectively highlight the potential of Ayurvedic therapies, dietary changes, and polyherbal formulations to enhance glycaemic control and prevent the progression from prediabetes to type 2 diabetes. 

•  Numerous objective tools for monitoring blood sugar levels, such as the Oral Glucose Tolerance Test (OGTT), HbA1c measurement, and the Indian Diabetes Risk Score , are essential in assessing diabetes risk and glycaemic control.^12,13 These conven tional methods can be effectively complemented by diagnostic approaches based on Ayurveda, which offer a more holistic perspective by evaluating an individual’s constitution, lifestyle, and underlying imbalances. Integrating Ayurveda-based diagnostics with conventional methods could provide a broader understanding of an individual's health, potentially leading to more personalized and effective management strategies for blood sugar regulation.
• Many studies have examined the role of Shodhana (Ayurvedic purification therapies), including Vamana (therapeutic emesis) and Virechana (therapeutic purgation), in the management of diabetes mellitus.¹⁴ These interventions also show potential for adoption in the management of prediabetes as well, opening avenues for future research to explore their efficacy and mechanisms in early-stage glycaemic regulation and diabetes prevention.
• Studies have also demonstrated the role of internal medicinal formulations in managing diabetes mellitus.^14-16 These oral Ayurvedic medications may also be beneficial for managing prediabetes, although further evaluation and documentation are needed in this direction.
• Ayurveda significantly emphasizes avoiding causative factors, whether food- or lifestyle-related, to prevent disease onset. In the context of Prameha, various dietary and lifestyle regimens have been recommended, some of which have been supported by documented studies.^17,18 Further research into these Ayurvedic guidelines could help establish effective strategies to prevent the progression from prediabetes into fully manifested diabetes mellitus.

Limitations

A limitation of the current study is that only eight articles were analyzed, which may not provide a sufficient basis for drawing definitive conclusions.

Despite the promising potential of Ayurvedic approaches in managing prediabetes, limitations such as the lack of standardized protocols, insufficient large-scale clinical trials, and the need for more rigorous scientific validation hinder their widespread acceptance and integration into conventional medical practice and the public health domain.

Conclusion

These studies collectively suggest that the integration of traditional Ayurvedic practices with contemporary scientific validation holds great promise in the prevention and management of prediabetes and related metabolic disorders.

• The studies demonstrate that Ayurvedic interven tions, such as Vamana Karma, Darvyadi Kwatha, and polyherbal formulations like Nisha-Amalaki, significantly improve glycaemic control, insulin sensitivity, and overall metabolic health. These approaches address the biochemical aspects of prediabetes and enhance physical and mental strength, contributing to a holistic improvement in quality of life.
• Crucially, the use of Ayurvedic diagnostic tools, such as the Prameha Purvarupa questionnaire, enables the identification of early symptoms and a better understanding of the pathogenesis of prediabetes. By recognizing these early signs, we can intervene at a stage when disease progression can still be reversed or halted. This understanding of pathogenesis helps break the cycle of metabolic imbalance, which, if left unchecked, can lead to fully manifested diabetes and systemic complications. The findings on dietary impacts, particularly curd and yogurt consumption, further underscore the need for personalized dietary guidelines for individuals at risk of prediabetes. 
• With its focus on prevention and metabolic health, Ayurveda could contribute to standardized protocols that complement conventional approaches. Global collaborations may bolster its scientific credibility, positioning Ayurveda as a valuable component of holistic prediabetes care. Continued clinical trials and research are crucial for validating and integrating these practices into mainstream healthcare, which could potentially transform diabetes prevention and management.

Conflict of Interest

Nil