Integrating Traditional Medicine in the Modern Management of Type 2 Diabetes Mellitus and Obesity: Mechanisms, Evidence, and Future Directions

Abstract

The rising trend of Type 2 Diabetes Mellitus (T2DM) and obesity across the globe is one of the most significant health problems of the 21st century. In accordance with the current epidemiological statistics provided by the International Diabetes Federation and the World Obesity Federation, an incredible increase in prevalence is projected, and an excess of 853 million people are predicted to live with diabetes by 2050. Although there has been tremendous progress in the pharmacotherapy of metabolic syndrome, which is typified by insulin resistance, dysfunction of the beta-cell, and chronic low-grade inflammation, it may be assumed that the complexity of this disease will outweigh the current reductionist one-drug-one-target paradigm. This is a comprehensive narrative review with structured literature synthesis, Traditional Chinese Medicine, and Unani systems of Traditional Medicine may be integrated into the modern metabolic management. We critically analyze the ethnopharmacological foundations and molecular mechanisms of key medicinal plants, including Gymnema sylvestre, Momordica charantia, Berberis aristata, Salacia reticulata, and Curcuma longa. Emerging evidence from systems pharmacology reveals that bioactive phytoconstituents such as gymnemic acids, charantin, berberine, and curcumin exert potent pleiotropic effects. These compounds regulate key metabolic hubs such as Adenosine Monophosphate-activated Protein Kinase (AMPK), Peroxisome Proliferator-Activated Receptors (PPARs) and the incretin axis Glucagon-like peptide-1 (GLP-1) and tend to mimic or improve the activity of pharmacological agents such as metformin and acarbose. Furthermore, we examine the transformative role of modern technologies, including network pharmacology, metabolomics, and Artificial Intelligence, in decoding the synergistic interactions inherent in polyherbal formulations. Clinical evidence from randomized controlled trials is synthesized to evaluate efficacy in glycemic control Glycated haemoglobin (HbA1c reduction) and weight management, while acknowledging the heterogeneity and methodological limitations of current data. Finally, the report addresses the imperative of rigorous safety monitoring, detailing the risks of herb-drug interactions (e.g., serotonin toxicity with Garcinia cambogia) and the regulatory landscapes of the Food and Drug Administration, WHO, and AYUSH. By bridging ancient wisdom with modern systems biology, this report advocates for a paradigm shift toward a holistic, evidence-based integrative model to combat the metabolic pandemic.