The Role of Herbal Supplements With Metformin in Managing Type 2 Diabetes Mellitus: Review Article

Diabetes mellitus represents a significant health challenge in India and worldwide, and its treatment traditionally involves combining synthetic and herbal drugs, which, along with diet and lifestyle modifications, can maximize therapy efficiency. Notably, while complementary medicines can potentially augment diabetes care, the first-line treatment for Type 2 Diabetes Mellitus (T2DM) remains metformin, a synthetic medication. This article aims to highlight the rationale for the clinical use of metformin and the circumstances under which it should not be prescribed. Herbal medicine has garnered considerable interest for its beneficial effects in T2DM management, primarily due to their traditional use, relative safety, and efficacy. This review provides preclinical and clinical evidence for the anti-diabetic potential of several commonly used medicinal plants, including Neem (Azadirachta indica), Turmeric (Curcuma longa), Cinnamon (Cinnamomum verum), Fenugreek (Trigonella foenum-graecum), Bitter Melon (Momordica charantia), Jamun (Syzygium cumini), and Aloe vera (Aloe barbadensis Miller). These plants are involved in reducing blood glucose levels via multiple mechanisms, namely, enhancing insulin secretion and sensitivity, inhibiting carbohydrate-digesting enzymes, and protecting pancreatic β-cells from damage. Moreover, this review describes the ethnobotanical applications of these plants, their phytochemistry, dosage, and recent clinical advances. The article also discusses the adjunctive use of these herbal medicines in combination with metformin to maximize therapeutic benefits for patients with DM.