Review Article

Exploring the social impacts of different treatment approaches towards diabetes mellitus: Contemporary versus complementary

Karishma Singh, Kuben Naidoo, Abdulhakeem Sulyman

Received: 22 Sept. 2025; Accepted: 27 Dec. 2025; Published: 06 Feb. 2026

Copyright: © 2026. The Authors. Licensee: AOSIS.
This work is licensed under the Creative Commons Attribution 4.0 International (CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/).

Abstract

Background: Diabetes mellitus, a chronic and widespread metabolic disorder, necessitates a variety of treatment strategies to address its complex and multifaceted nature. Modern treatments like medication, insulin, and lifestyle interventions are evidence based and widely trusted, while complementary treatments are culturally rooted and take a holistic approach to health.

Aim: This study compared the social impacts of contemporary and complementary diabetes treatment approaches, focusing on patient behaviour, cultural acceptance, healthcare costs, and overall societal perceptions of health.

Setting: This review presents a comprehensive global overview of approaches to diabetes treatment.

Method: A comprehensive literature search was conducted across major electronic databases, including Scopus, Google Scholar, Google Books, ScienceDirect, ResearchGate, PubMed, CINAHL, Web of Science, and International Diabetes Federation to gather the most current information. A total of 57 articles were selected and reviewed.

Results: Findings revealed that modern diabetes treatments are often costly and can be limited by issues of cultural sensitivity and access, while complementary treatments tend to be more affordable and culturally acceptable but lack strong scientific validation.

Conclusion: The integration of complementary treatments with conventional care appears to be a promising approach, with the potential to improve patient satisfaction and health outcomes by combining the strengths of both treatment modalities.

Contribution: The findings offer valuable insights for clinicians, researchers, and policy makers seeking to design more culturally responsive and patient-centered diabetes strategies.

Keywords: diabetes; insulin resistance; medicinal plants; traditional medicine; contemporary treatments; social impacts.

Introduction

Diabetes mellitus is a chronic condition characterised by the body’s inability to regulate blood glucose levels (Harvard 2021). It affects millions of people worldwide and poses a significant public health risk. The increasing prevalence of this chronic disease is a result of significant socioeconomic changes (Cooper, Simmons & Anderson 2021). Understanding the global scope of diabetes entails investigating its incidence, the factors driving its rise, and efforts to mitigate its impact. Diabetes affects an estimated 537 million adults worldwide, with a trajectory to increase to 643 million by 2030 and 783 million by 2045, taking current trends into account (Atlanta 2020; International Diabetes Federation [IDF] 2021). This alarming increase is primarily caused by type 2 diabetes (T2D), which accounts for more than 90% of all diabetes cases (Atlanta 2020; World Health Organization [WHO] 2020). Type 1 diabetes (T1D), while less common, has shown a gradual increase, particularly among young people (IDF 2021). The prevalence of diabetes varies greatly across regions. Diabetes is more common in low- and middle-income countries, where most of the global diabetes burden is concentrated because of rapid urbanisation, lifestyle changes, and inadequate healthcare and dietary systems (IDF 2021). For example, the Western Pacific and Southeast Asia regions are home to nearly half of all adults with diabetes, with China and India accounting for a sizable proportion of global cases. Diabetes prevalence is increasing in high-income countries as well, although at a slower rate than in developing countries (IDF 2021; WHO 2020). Ageing populations, sedentary lifestyles, and dietary habits are major contributing factors. While conventional biomedical interventions, such as insulin therapy and oral hypoglycaemics, remain important in diabetes care, many people also use complementary or traditional therapies to manage their disease. This article seeks to review the social consequences of contemporary (biomedical) versus complementary (alternative or traditional) treatment approaches, with a particular emphasis on patient perceptions, socio-cultural integration, economic burden, health-seeking behaviour, and quality of life.

Methods

A comprehensive literature search was carried out using several academic databases, including PubMed, Scopus, Web of Science, CINAHL, and Google Scholar. To capture non-peer-reviewed insights, grey literature was consulted, including reports from the WHO, IDF, and national health departments. The search covered publications from January 2010 to July 2025, capturing current research trends and evolving understanding of diabetes treatment. Relevant published articles were reviewed and summarised when applicable. Keywords in the search included diabetes management, contemporary biomedical therapies, complementary and alternative therapy options, patient experiences, and social or economic consequences. Clear inclusion and exclusion criteria were devised to screen and assess the relevance of the discovered studies. Selected articles were examined independently to determine eligibility and extract relevant study findings. All consulted sources were properly referenced.

In total, 87 articles were discovered, with 57 meeting the inclusion requirements and being thoroughly examined. The review technique employed was to analyse relevant material as soon as it was identified to ensure correctness and coherence when synthesising findings.

Ethical considerations

This article followed all ethical standards for research without direct contact with human or animal subjects.

Review findings

Overview of treatment modalities

Diabetes management includes a variety of treatment approaches, ranging from modern methods involving medication and lifestyle changes to complementary therapies such as herbal medicine and acupuncture.

Contemporary (biomedical) approaches

Contemporary diabetes treatments primarily include pharmacological interventions, lifestyle changes, and the use of glucose-monitoring technology. These methods are evidence-based and widely used in conventional medicine (Lee et al. 2019).

Pharmaceutical treatments

Insulin, metformin, and sulfonylureas are common medications prescribed to diabetic patients to control blood glucose levels. Insulin therapy is especially important for people with T1D and T2D who do not get enough control from oral medications alone. Commonly used diabetes drugs include: insulin, biguanides, sulfonylureas, meglitinides, thiazolidinediones (TZDs), Alpha-Glucosidase Inhibitors, Dipeptidyl Peptidase-4 (DPP-4) Inhibitors, Sodium-Glucose Co-Transporter-2 (SGLT2) Inhibitors, and Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists. Other treatments include gene therapy and dual agonists (Lee et al. 2019).

Lifestyle modifications

Dietary changes, regular physical activity, and weight management are all important aspects of diabetes management. These interventions help to control blood glucose levels while also lowering the risk of complications such as cardiovascular disease and neuropathy (Barnard, Hernandez & Jenkins 2015).

Technological advancements

The introduction of continuous glucose monitors (CGMs) and insulin pumps has transformed diabetes care. These technologies provide real-time glucose readings and automated insulin delivery, which improves glycaemic control and reduces patients’ disease management burden (Ahmadi, De Backer & Dovc 2020).

Contemporary treatments have significantly improved the quality of life for diabetics. Improved glucose control lowers the risk of complications, resulting in fewer hospitalisations and a longer, healthier life (Nascimento et al. 2025). Access to advanced technologies such as CGMs and insulin pumps enables more precise management, allowing patients to live more active and fulfilling lives.

While modern diabetes medications have transformed the management of diabetes, they are not without drawbacks. Issues such as variable efficacy, side effects, high costs, limited access, and patient adherence challenges highlight the importance of continuous innovation and improvement in diabetes treatment. Some of the challenges experienced by patients include and are not limited to the following (Deressa et al. 2024; Nascimento et al. 2025):

• Patients with diabetes frequently require additional medications for hypertension and dyslipidaemia to manage their cardiovascular risk.
• Insulin therapy and oral hypoglycaemic agents help to manage blood sugar levels, but they do not address the underlying pathophysiology of diabetes, necessitating lifelong treatment.
• Diabetes patients with depression, according to studies, are less likely to adhere to their medication regimens and have poorer health outcomes than those without depression.
• Despite the potential benefits for glycaemic control, a significant number of T2D patients postpone starting insulin therapy because of a fear of injections.
• Patients on insulin therapy must manage not only their medication but also their diet and physical activity, which makes adherence difficult and increases the risk of medication errors.
• Because of limited healthcare resources, many patients in sub-Saharan Africa and South Asia are unable to access even basic diabetes medications such as insulin and metformin.
• The high cost of insulin has been a major issue, with many patients having to ration their doses or skip treatments entirely.
• Patients on insulin therapy frequently gain significant weight, which has a negative impact on their cardiovascular health and overall disease management.
• Patients who were initially well controlled with sulfonylureas may eventually require insulin therapy as their pancreatic beta cells lose their ability to produce insulin. Furthermore, a study found that older adults taking sulfonylureas had a higher rate of hypoglycaemia-related hospitalisations than those taking other medications.

The high cost of current diabetes treatments can be a barrier to access, especially in low- and middle-income countries (WHO 2020). The need for regular medication, glucose monitoring supplies, and advanced technologies can result in significant healthcare costs, affecting the affordability and availability of care.

Healthcare professionals and society generally accept and support contemporary treatments; however, there may still be a stigma attached to the visible aspects of diabetes management, such as insulin injections and glucose monitoring. Education and awareness campaigns are critical for reducing stigma and increasing acceptance.

Complementary medicine

Herbal medicine, acupuncture, and dietary supplements are examples of complementary diabetes treatments. These methods are frequently combined with conventional treatments to improve overall health and well-being. For centuries, herbal remedies such as bitter melon, fenugreek, and berberine have been used to treat diabetes symptoms. These natural treatments are believed to have hypoglycaemic properties and are widely used in many cultures around the world (Holistic Diabetes Care 2022).

African traditional medicine

With the prevalence and rapid increase of diabetes in Africa, many people rely on traditional medicine to manage their condition (Eddouks 2012; Tsabang et al. 2016). African traditional medicine has a long history that predates written records and has been passed down through oral traditions (Tsabang et al. 2016). Traditional healers, also known as herbalists, diviners, or spiritual healers, play an important role in African communities, providing treatments for a variety of health issues using natural remedies derived from plants, animals, and minerals (Eddouks 2012; Tsabang et al. 2016). Ailments such as diabetes are often well treated by traditional remedies.

Traditional medicine in Africa is inextricably linked with cultural beliefs and practices (Sagbo & Hussein 2022; Tsabang et al. 2016). It is based on a holistic approach to health that considers an individual’s physical, spiritual, and social needs. This holistic approach is especially important in the management of chronic conditions such as diabetes, which necessitates comprehensive care that addresses not only physical symptoms but also emotional and lifestyle factors associated with the disease.

African traditional medicine provides a wide range of diabetes treatments, many of which are derived from local flora and fauna (Eddouks 2012). The following are some of the most widely used traditional diabetes treatments in Africa.

Herbal remedies in African traditional medicine

Herbal medicine is a key component of African traditional medicine (Eddouks 2012; Sagbo & Hussein 2022). Many plants used in traditional remedies have been shown to have hypoglycaemic properties, which can help to lower blood sugar levels. Some commonly used herbs for diabetes management are as follows (Chauhan et al. 2010; Sagbo & Hussein 2022; Figure 1):

• Moringa oleifera Lam: Moringa leaves, which are rich in antioxidants, are used to help regulate blood sugar levels (Figure 1a).
• Vernonia amygdalina Delile. (Bitter Leaf): This plant is commonly used in West Africa to treat diabetes. It is thought to boost insulin sensitivity and reduce blood glucose levels (Figure 1b).
• Momordica charantia L. (Bitter Melon): Bitter melon is widely used in African cultures to treat diabetes. It contains compounds that mimic insulin and aid in blood sugar regulation (Figure 1c).
• Aloe vera L. Burman: Some African communities use Aloe vera juice to improve glycaemic control and reduce inflammation (Figure 1d).
• Ocimum gratissimum L. (African Basil): Is used in traditional medicine to treat diabetes because of its blood sugar-lowering properties (Figure 1e).

FIGURE 1: Medicinal plants used as therapeutics for diabetes mellitus. (a) Moringa oleifera; (b) Vernonia amygdalina; (c) Momordica charantia; (d) Aloe vera; (e) Ocimum gratissimum; (f) Trigonella foenum-graecum; (g) Emblica officinalis; (h) Cinnamomum verum; (i) Gymnema sylvestre; (j) Panax ginseng; (k) Astragalus membranaceus; (l) Coptis chinensis; (m) Rehmannia glutinosa.

Animal-based remedies

In addition to plants, African traditional medicine uses animal products to manage diabetes. These treatments are frequently based on the belief that certain animal parts or extracts can impart beneficial properties to the patient (Eddouks 2012):

• Snail Mucus: In some African traditions, snail mucus is used for its purported healing and anti-inflammatory properties, which are thought to aid in diabetes management and complications.
• Bee Products: Honey, propolis, and bee venom are used in traditional medicine for their potential anti-diabetic benefits. Honey is often used as a sugar substitute.

Spiritual and ritual practices

African traditional medicine frequently incorporates spiritual and ritual practices that are thought to aid in healing. These practices could include prayers, offerings, and consultations with spiritual healers (Chetty, Govender & Reddy 2022). Many patients value the spiritual aspect of traditional medicine, as it provides a sense of hope and psychological support in addition to physical treatment.

The scientific community is increasingly interested in the efficacy of African traditional medicine in the management of diabetes (Chetty et al. 2022). While many traditional remedies are empirically based and have been used successfully for centuries, scientific validation is required to ensure their safety and efficacy.

Several studies have investigated the hypoglycaemic properties of various African traditional herbs. In animal models, V. amygdalina has been shown to significantly reduce blood glucose levels and improve insulin sensitivity (Sagbo & Hussein 2022). In both human and animal studies, M. oleifera has been shown to reduce blood sugar levels and improve overall metabolic health (Sagbo & Hussein 2022).

However, many of these studies are preliminary and frequently lack the rigor found in large-scale clinical trials. More research is required to standardise dosages, identify active compounds, and assess the long-term efficacy of these traditional remedies. Validation of the safety, toxicity, and efficacy still needs further consideration (Chetty et al. 2022; Eddouks 2012). Patients should consult with healthcare providers to ensure that any traditional treatments are safe and do not interfere with their current treatment regimens.

While African traditional medicine provides valuable insights and potential treatments for diabetes, several challenges must be addressed to improve its integration with modern healthcare (Chetty et al. 2022). One of the most significant challenges is the lack of standardisation in traditional medicine. Remedies differ greatly in terms of preparation, dosage, and administration, making it difficult to assess their efficacy and safety. Efforts to standardise traditional treatments and ensure quality control are critical for their effective integration into modern healthcare. There is a need for more rigorous research to validate the efficacy and safety of traditional diabetes treatments. This includes carrying out clinical trials, identifying active compounds, and investigating the mechanisms of action. Increased funding and support for traditional medicine research can help to close the gap between empirical knowledge and scientific evidence.

Indian traditional medicine (Ayurvedic)

In India, where diabetes prevalence has reached alarming levels, traditional medicine systems such as Ayurveda, Siddha, and Unani provide novel approaches to managing the disease (IDF 2019; Sadiku et al. 2019). Indian traditional medicine includes a wide range of herbal remedies, dietary practices, and holistic treatments that have been used for centuries to promote health and treat a variety of ailments, including diabetes (Sadiku et al. 2019; Sen & Chakraborty 2017).

Ayurveda

Ayurveda, one of the world’s oldest holistic healing systems, began in India over 3000 years ago (Sadiku et al. 2019). It is founded on the principle of balance between the body, mind, and spirit and includes a variety of treatments, such as herbal medicine, diet, exercise, and meditation.

Siddha

The Siddha system, which is primarily practised in South India, is another ancient medical system that emphasises the use of herbs, minerals, and dietary guidelines to maintain health and treat disease. It focuses on achieving harmony among the body’s humours: Vatha, Pitha, and Kapha. A Siddha diet emphasises consuming whole grains, pulses, and bitter vegetables while avoiding sugary and processed foods (Kumar & Kaur 2021). Diabetes care powder (Diabcare Chooranam) is a traditional formulation containing a blend of herbs that help regulate blood sugar levels (Madhavan & Sreelatha 2016). In addition, Kudineer is a herbal decoction made from various herbs, often prescribed for its detoxifying and blood sugar-lowering properties (Pattabiraman & Janakiraman 2019). Furthermore, regular physical activity is encouraged to improve insulin sensitivity and overall health (Kumar & Kaur 2021).

Unani

Unani medicine, influenced by Greek and Arabic traditions, focuses on balancing the four humours (blood, phlegm, yellow bile, and black bile) (Ismail et al. 2024). It uses a variety of herbal and natural remedies outlined next to improve health and treat conditions such as diabetes (Ismail et al. 2024).

Herbal remedies in Indian traditional medicine

Herbal medicine plays an important role in Indian traditional medicine. Various herbs are used to treat diabetes by lowering blood sugar, increasing insulin sensitivity, and improving overall metabolic health (Figure 1) (Chauhan et al. 2010; Sadiku et al. 2019):

• Bitter gourd (M. charantia): Bitter gourd is widely used in Ayurveda due to its hypoglycaemic properties. It contains charantin, vicine, and polypeptide-p, which have been shown to reduce blood glucose levels by improving insulin secretion and glucose utilisation (Figure 1c).
• Fenugreek (Trigonella foenum-graecum L.): Fenugreek seeds are known for their ability to increase glucose tolerance and lower blood sugar levels. The seeds contain soluble fibre and trigonelline, which decrease carbohydrate absorption and increase insulin production (Figure 1f).
• Indian Gooseberry (Emblica officinalis Gaertn.): Indian gooseberry, or amla, is rich in vitamin C and antioxidants. It has been shown to help regulate blood sugar levels and improve pancreatic function by enhancing the body’s antioxidant defences (Figure 1g).
• Cinnamon (Cinnamomum verum J. Presl.): Cinnamon is widely used in traditional medicine and cuisine because of its ability to lower blood sugar levels. It improves insulin sensitivity and has a positive impact on lipid profiles (Figure 1h).
• Gymnema sylvestre (Retz.) R.Br. ex Sm.: G. sylvestre, known as ‘sugar destroyer’ in Ayurveda, contains gymnemic acids, which help block sugar absorption in the intestines and increase insulin secretion (Figure 1i).

Several clinical studies have shown that Indian traditional medicine is effective in managing diabetes (Chauhan et al. 2010; Sadiku et al. 2019). In both animal and human studies, bitter gourd has been shown to lower blood sugar levels and improve insulin sensitivity (Wang et al. 2013; also see Table 1). Similarly, Fenugreek has been shown to improve glycaemic control and reduce fasting blood sugar levels in diabetic patients. A study by Saeedi, Tohidast and Khosravi (2018) demonstrated that patients with T2D who consumed fenugreek powder experienced marked improvements in glucose levels over a 12-week period (Table 1). Gymnema sylvestre has shown significant hypoglycaemic effects by increasing insulin secretion and glucose uptake in cells (Chauhan et al. 2010). A study by Rout, Kedia and Singh (2013) found that participants who consumed G. sylvestre capsules exhibited significant reductions in blood glucose levels after 12 weeks of supplementation (Table 1). These findings demonstrate the potential for traditional remedies to supplement modern diabetes treatments.

Indian traditional medicine provides a wealth of knowledge and practices for diabetes management, including a variety of herbal remedies, dietary practices, and lifestyle changes (Sadiku et al. 2019). While there is an increasing interest in scientifically validating these Indian traditional treatments, more research is required to confirm their efficacy and safety. Integrating traditional medicine with modern healthcare practices can offer a more comprehensive approach to diabetes management, improving patient outcomes and promoting holistic care. The Indian government has 1recognised the importance of traditional medicine and has established the Ministry of AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homoeopathy) to regulate and promote these practices (Nature Medicine 2021). This includes developing guidelines for the safe and effective use of traditional remedies and supporting research to validate their efficacy.

Chinese traditional medicine

In China, where the prevalence of diabetes has risen sharply in recent years, Traditional Chinese Medicine (TCM) offers a unique and time-honoured approach to managing the disease. Traditional Chinese Medicine, with its holistic perspective and emphasis on natural remedies, has been used for centuries to treat various ailments, including diabetes (Luo, Fabre & Rodwin 2019). Traditional Chinese Medicine is a comprehensive medical system that has been used for more than 2000 years (Luo et al. 2019). It is founded on the concepts of balance and harmony within and between the body and nature. Traditional Chinese Medicine encompasses a diverse set of practices, including herbal medicine, acupuncture, dietary therapy, and Qi Gong, all of which aim to restore and maintain health by balancing the body’s vital energy, or Qi (Holmes & Linong 2014).

Core concepts of Chinese traditional medicine

The following are core concepts of Chinese traditional medicine:

• Qi and Blood: Qi (vital energy) and blood are both fundamental concepts in TCM (Meng et al. 2023) Health depends on the proper flow and balance of Qi and blood. Diabetes is frequently viewed because of Qi deficiency and poor blood circulation (Matos et al. 2021).
• Yin and Yang: The balance of Yin and Yang (opposite but complementary forces) is essential for good health. Diabetes is viewed as an imbalance in which excessive Yang or insufficient Yin causes symptoms such as thirst, weight loss, and fatigue (Matos et al. 2021).
• Five Elements: TCM also emphasises the interaction of the five elements (wood, fire, earth, metal, and water), each of which corresponds to a specific organ or bodily function (Holmes & Linong 2014; Matos et al. 2021). The spleen and kidneys, which are connected to earth and water, respectively, are particularly important in diabetes management.

Common Traditional Chinese Medicine remedies for diabetes

Herbal medicine: Herbal medicine is a fundamental component of TCM, involving the use of plants and natural substances to restore balance and treat a variety of health conditions, including diabetes. Several herbs are widely used to control blood sugar and improve overall health (Liu 2024; Long 2025; Luo et al. 2019):

• Ginseng (Panax ginseng C.A. Mey): Ginseng is highly valued in TCM for its ability to increase energy and improve glucose metabolism. Ginseng has been shown in studies to reduce blood sugar levels by increasing insulin secretion and sensitivity (Figure 1j).
• Astragalus (Astragalus membranaceus (Fisch.) Bunge): Astragalus is renowned for its immune-boosting and anti-inflammatory properties. It is used in TCM to increase insulin sensitivity, protect pancreatic cells, and lower blood glucose levels (Figure 1k).
• Bitter Melons (M. charantia): Bitter melon is widely used in TCM to treat diabetes because of its hypoglycaemic properties. It contains compounds that act like insulin and help regulate blood sugar levels by increasing glucose uptake in cells (Figure 1c).
• Coptis chinensis Franch. (Huan Lian): C. chinensis, also known as Huang Lian, is used to treat inflammation and hyperglycaemia. It contains berberine, which has been shown to increase insulin sensitivity and lower blood glucose levels (Figure 1l).
• Rehmannia glutinosa (Gaertn.) DC.: Rehmannia is used in TCM to nourish Yin (female health) and tone the kidneys, which are frequently linked to diabetes. It regulates blood sugar levels and promotes overall metabolic health (Figure 1m).

Acupuncture: Acupuncture, a crucial part of TCM, entails inserting fine needles into specific points on the body to stimulate the flow of Qi and restore balance (Mah 2017). It is used to manage diabetes by improving insulin sensitivity, lowering blood sugar levels, and relieving symptoms such as neuropathy:

• Diabetes Acupoints: ST36 (Zusanli), SP6 (Sanyinjiao), and LI4 (Hegu) are common acupoints used to treat diabetes. They are thought to improve pancreatic function, metabolism, and blood sugar regulation.
• Mechanism of Action: According to research, acupuncture can influence the nervous system, increase endorphin release, and improve blood flow, all of which may contribute to its beneficial effects on glucose metabolism.

Numerous studies have investigated the effectiveness of TCM in managing diabetes, with a particular emphasis on herbal medicine and acupuncture (Holmes & Linong 2014; Luo et al. 2019; Mah 2017). For example, Berberine, an active compound found in C. chinensis, has been shown in studies to significantly lower blood glucose levels and improve insulin sensitivity in diabetic patients (Luo et al. 2019). Similarly, clinical trials on Ginseng have demonstrated its ability to improve glucose metabolism and lower fasting blood sugar levels. Acupuncture has also been researched for its effects on diabetes, with several studies indicating that it can improve insulin sensitivity and lower blood glucose levels in type 2 diabetic patients (Mah 2017).

Traditional Chinese Medicine provides a wealth of information and practices for managing diabetes, including herbal remedies, acupuncture treatments, and dietary therapies. While there is an increasing interest in scientifically validating these traditional treatments, more research is required to confirm their efficacy and safety (Central Committee and State Council [CCP] 2016). Integrating TCM into modern healthcare practices can provide a more comprehensive approach to diabetes management, improving patient outcomes and promoting holistic care (Holmes & Linong 2014; Luo et al. 2019). The Chinese government has recognised the significance of TCM and has enacted regulations to ensure its safe and effective application (CCP 2016). This includes creating guidelines for the standardisation of herbal products and funding research to validate their effectiveness. Traditional Chinese Medicine is also integrated into the national healthcare system, giving patients access to both traditional and modern therapies.

Common folklore practices

While modern medicine offers effective treatments, many cultures around the world continue to use traditional and folkloric practices to manage diabetes (Gucciardi et al. 2019; IDF 2021). These practices, which are frequently rooted in centuries-old traditions and passed down through generations, provide unique perspectives and solutions for managing blood sugar levels and improving overall health.

Folklore medicine, also known as folk or traditional medicine, refers to a diverse set of healing practices and beliefs that are unique to different cultures (Gucciardi et al. 2019; Sharma 2015). These practices frequently use natural resources such as herbs, foods, and minerals. The environment, cultural beliefs, and availability of natural resources have all had an impact on folklore practices for diabetes management in various regions (Reid et al. 2018).

Apart from herbal remedies previously discussed, in folklore medicine, diet plays an important role in diabetes management (Gucciardi et al. 2019; Sharma 2015). These practices frequently involve eating specific foods that are thought to have a positive impact on blood sugar levels and overall health. These include:

• Low Glycaemic Foods: Many traditional diets emphasise the consumption of low-glycaemic foods such as whole grains, legumes, and vegetables, which help to keep blood sugar levels stable. These foods digest slowly, which prevents blood glucose spikes.
• Bitter foods: In many cultures, bitter foods are thought to be beneficial for diabetes management. Bitter gourd, neem leaves, and bitter herbs are used to control blood sugar and improve digestion.
• Portion Control: Traditional dietary practices frequently emphasise portion control and eating smaller, more frequent meals to maintain stable blood sugar levels and avoid overeating.
• Natural Sweeteners: In many folklore practices, natural sweeteners such as honey and agave nectar replace refined sugars. These sweeteners are thought to have a smaller impact on blood sugar levels than processed sugars.

In many cultures, spiritual and ritual practices are an important part of folklore medicine for diabetes management. These practices frequently include the use of prayer, meditation, and rituals to promote healing and harmony as outlined below (Al Fariqi 2023; Reid et al. 2018; Sharma 2015):

• Energy healing: Energy healing practices such as Reiki and Qi Gong are used in many cultures to balance the body’s energy and promote healing. These practices are thought to help with insulin sensitivity and overall metabolic health.
• Prayers and healing rituals: Many indigenous cultures practice prayer and healing rituals to seek divine intervention and support in managing diabetes. These rituals frequently include the use of sacred herbs, chants, and ceremonies to aid in healing.
• Meditation and mindfulness: Meditation and mindfulness practices are widely used in Eastern cultures to reduce stress and improve overall health. These practices are thought to help regulate blood sugar levels by mitigating the effects of stress on the body.
• Dietary supplements: Supplements such as chromium, magnesium, and alpha-lipoic acid are frequently used to improve blood glucose control and lower the risk of complications. These supplements are thought to improve insulin sensitivity and metabolic health.

Folklore medicine takes a holistic approach to health that includes the body, mind, and spirit. This approach can lead to a more complete understanding of health and disease, promoting overall well-being and balance. Many folklore practices rely on readily available and inexpensive natural resources, making them accessible to a wide range of people (Reid et al. 2018). This can be especially useful in low-income or rural areas where access to modern healthcare is limited.

While many folklore practices show promise for diabetes management, more research is needed to validate their efficacy and ensure their safety when combined with modern medical treatments. Healthcare providers can better support patients on their diabetes management journey and promote overall health and well-being if they respect and understand the cultural significance of these practices.

Social impacts of complementary treatments versus contemporary treatments

Contemporary treatments for diabetes are primarily focused on controlling blood glucose levels, preventing complications, and improving quality of life. These treatments include medications, lifestyle modifications, and medical monitoring, whereas complementary treatments for diabetes involve a wide range of practices that are used alongside or in place of conventional treatments, including herbal medicines, acupuncture, dietary supplements, and mind-body therapies (Kavitha, Ramesh & Johnson 2020).

Cultural acceptance and social perceptions

Contemporary diabetes treatments are widely accepted and trusted in many societies, particularly in industrialised countries where scientific research and technological advancements play an important role in healthcare (Kavitha et al. 2020). The use of evidence-based practices builds trust and credibility among patients and healthcare providers, resulting in widespread acceptance and use of contemporary treatments. In diverse societies, contemporary treatments are frequently modified to accommodate cultural beliefs and practices, thereby increasing their acceptability and effectiveness across populations (Singh, Thomas & Kumar 2019). However, in some communities, there may be a gap between modern medical practices and traditional beliefs, affecting treatment adherence and patient outcomes.

Complementary diabetes treatments are deeply rooted in cultural traditions and frequently align with patients’ personal beliefs and values (Kavitha et al. 2020; Singh et al. 2019). Complementary and Alternative Medicine (CAM) practices provide patients with a sense of continuity with ancestral traditions while also aligning with holistic health approaches, providing comfort and familiarity. While complementary treatments are widely used in many cultures, they may be viewed sceptically in societies that value scientific evidence and conventional medicine. Patients who use CAM may face social pressure to conform to current medical practices, which can influence their willingness to pursue alternative therapies (Rahman, Hosseinzadeh & Hasnain 2021).

Patient behaviour and decision-making

Patients who choose contemporary treatments frequently do so because they believe in scientific evidence and the recommendations of healthcare professionals (Rahman et al. 2021). Patients are more likely to follow treatments that are supported by clinical evidence and recommended by their doctors, resulting in improved health outcomes and adherence to prescribed therapies (Hsu et al. 2023). The possibility of side effects and complications from current treatments can influence patient decisions, leading some to seek alternative therapies or combine conventional and complementary approaches (Gupta, Das & Sengupta 2019).

Furthermore, these patients frequently value a holistic approach to health and seek therapies that are consistent with their personal beliefs and preferences (Rahman et al. 2021; Singh et al. 2019). Complementary and Alternative Medicine practices encourage patients to actively participate in their health and well-being, instilling a sense of control and self-care. This empowerment can result in higher patient satisfaction and engagement in their treatment plans. Many patients prefer to combine complementary treatments with conventional care, seeking a balanced approach that benefits both medical systems (Perez, Gutierrez & Lopez 2018; Zhang, Chen & Liu 2018), which ultimately improves patient outcomes and overall quality of life.

Healthcare costs and economic impacts

Diabetes treatments today frequently include advanced technologies, medications, and specialised medical services, all of which can be expensive (Hsu et al. 2023; Rahman et al. 2021). The cost of modern medical care can contribute to rising healthcare costs and economic disparities because not all patients can afford expensive therapies or have access to comprehensive health insurance (Gupta et al. 2019). Contemporary treatments are typically covered by health insurance plans, reducing the financial burden on patients (O’Brien, Bock & Sargut 2020). However, disparities in insurance coverage can result in unequal care and health outcomes.

Complementary diabetes treatments are generally more affordable and accessible, especially in low-income and rural communities where conventional medical services are limited (Rahman et al. 2021; Singh et al. 2019). Complementary and Alternative Medicine practices frequently involve lower costs for treatment and maintenance of health, making them an appealing option for people looking for affordable healthcare solutions (Gupta et al. 2019; Singh et al. 2019). Despite their cost-effectiveness, complementary treatments may be excluded from health insurance plans, limiting their availability and integration into mainstream healthcare systems. This lack of coverage can create barriers for patients who want to try CAM therapies.

Social and psychological impacts

Modern treatments can have significant social and psychological consequences for patients and their families (Chukwuma 2018). Patients undergoing contemporary treatments frequently benefit from strong social support networks, which include family, friends, and healthcare providers (Chukwuma 2018; Fagninou et al. 2019). This support can improve emotional well-being and health outcomes. The use of modern treatments may be associated with social stigma, especially for chronic conditions such as diabetes that necessitate ongoing medical care. Patients may feel vulnerable and out of control over their health (Fagninou et al. 2019).

Complementary treatments can provide social and psychological benefits by instilling a sense of community and cultural identity. Complementary and Alternative Medicine practices frequently include community-based activities and group support, which improve social connections and foster a sense of belonging (Perez et al. 2018). This community involvement can boost mental health and overall well-being. Many complementary treatments include spiritual and mind-body practices, giving patients a greater sense of fulfilment and purpose (Cooper et al. 2021). This comprehensive approach can reduce stress, improve coping mechanisms, and improve overall well-being.

Implications and recommendations

Future recommendations towards sustainable drug discovery

Sustainable drug discovery for diabetes necessitates a multifaceted approach that incorporates cutting-edge technologies, encourages collaboration, and prioritises environmental and patient-centric practices. The pharmaceutical industry can create innovative and effective diabetes treatments by combining multi-omics technologies, artificial intelligence (AI) and machine learning (ML), green chemistry, and public–private partnerships (Franco et al. 2020). Enhancing patient involvement and promoting open science will ensure that these treatments meet the needs of diabetics while also contributing to a more sustainable and equitable healthcare system (Furman & Muller 2020). As the prevalence of diabetes rises, these recommendations will be critical to advancing drug discovery and improving the lives of millions of people worldwide.

The traditional process of drug discovery is lengthy, costly, and often fraught with high failure rates. For diabetes, the challenges include (Khan & Pillay 2020): (1) Diabetes pathophysiology is complex, with genetic, environmental, and lifestyle factors all playing a role, making it difficult to effectively target a single pathway; (2) Existing animal models and in vitro systems may not accurately simulate human diabetes, resulting in disparities in drug efficacy and safety; (3) A large number of potential drugs fail in clinical trials because of insufficient efficacy or safety concerns, resulting in significant financial losses. Despite these obstacles, there have been significant advances in diabetes treatment, including (Halban et al. 2021):

• The development of GLP-1 receptor agonists, SGLT2 inhibitors, and DPP-4 inhibitors has resulted in new therapeutic options that improve glycaemic control while also providing weight loss and cardiovascular protection.
• Advances in genomics and precision medicine have enabled more tailored treatments, increasing efficacy while reducing side effects.

Integrating multi-omics approaches, such as genomics, proteomics, metabolomics, and transcriptomics, can provide a thorough understanding of the molecular mechanisms underlying diabetes (Halban et al. 2021; Kahn, Cooper & Del Prato 2021). This comprehensive approach can help to identify new biomarkers and therapeutic targets, accelerating drug discovery.

The adoption of AI and ML can revolutionise drug discovery by making it easier to analyse large datasets, predict drug interactions, and identify potential drug candidates (Rosen & Spiegelman 2019). Furthermore, AI and ML can significantly reduce the time and cost of drug discovery, improve drug candidate selection accuracy, and predict clinical trial outcomes (Dankwa-Mullan et al. 2019).

Green chemistry is concerned with developing chemical processes that have a low environmental impact, generate less waste, and improve the sustainability of drug production (Halban et al. 2021). This approach is critical for developing environmentally friendly diabetes medicines, as it promotes the use of renewable resources, reduces reliance on toxic reagents, lowers energy consumption, and encourages regulatory bodies to incentivize pharmaceutical companies to adopt green chemistry practices. (Halban et al. 2021; Rosen & Spiegelman 2019). Green chemistry has the potential to lead to the development of environmentally sustainable drugs, lower pharmaceutical manufacturing’s carbon footprint, and promote responsible natural resource use.

Collaboration between public research institutions and private industry can maximise resources, expertise, and funding, accelerating the discovery and development of new diabetes treatments (Thompson, Kessler & Williams 2017). This can be accomplished by forming public–private research consortia focused on diabetes drug discovery, as well as developing funding mechanisms that encourage collaborative research and incentivise innovation (Franco et al. 2020). Public–private partnerships can help to share knowledge and technology, improve drug discovery efficiency, and get new treatments to market faster.

The promotion of Open Science and Data Sharing fosters transparency, collaboration, and innovation, allowing researchers to build on each other’s work and accelerate the discovery of new diabetes treatments (Furman & Muller 2020). Open access repositories for sharing research data, protocols, and findings on diabetes drug discovery should be created and maintained (Perez et al. 2018). Furthermore, creating online platforms allows researchers around the world to collaborate and exchange knowledge (Perez et al. 2018). Open science can reduce duplication of effort, improve research reproducibility, and promote a more collaborative and efficient drug discovery process (Kahn et al. 2021).

Incorporating patients’ perspectives into drug development can increase the relevance and acceptability of new treatments, ensuring that they meet the needs and preferences of diabetics (Perez et al. 2018). Involving patients in the design and execution of clinical trials helps to gain insight into their experiences and preferences. Use patient-reported outcomes to evaluate how new treatments affect quality of life and daily functioning. Patient-centred approaches can help to develop more effective and acceptable treatments, increase patient adherence, and improve overall health outcomes (Cooper et al. 2021).

The rising prevalence of diabetes necessitates innovative and long-term drug discovery approaches to develop effective therapies that address the disease’s underlying mechanisms.

Conclusion

Contemporary treatments are supported by a strong evidence base that demonstrates their effectiveness in controlling blood glucose levels and reducing complications. In contrast, complementary treatments frequently lack rigorous clinical trials, and their efficacy varies. However, some complementary therapies have shown promise in preliminary studies and are now being investigated further in scientific research. Both contemporary and complementary approaches can encourage patients to take an active role in their diabetes management. Contemporary methods offer precise tools for monitoring and controlling blood glucose levels, whereas complementary treatments take a more holistic approach that considers overall health and lifestyle factors. Integrating modern and complementary treatments can provide a more holistic approach to diabetes management. This co-management can improve patient outcomes by combining the benefits of both approaches. Lifestyle changes and herbal supplements, for example, can be used in conjunction with pharmaceutical treatments to provide a more holistic approach to care.

The investigation of social consequences of contemporary versus complementary treatment approaches for diabetes mellitus highlights the multifaceted nature of healthcare and emphasises the importance of a nuanced understanding of patient experiences and societal influences. Contemporary treatments, based on rigorous scientific research and technological advancements, offer robust and effective diabetes management solutions. These treatments are frequently associated with high levels of trust and adherence, particularly in societies with established healthcare systems that value evidence-based medicine. However, the high costs and potential cultural insensitivity of modern treatments can create barriers for certain patient populations, resulting in disparities in access and outcomes.

In contrast, complementary treatments provide a culturally appropriate and holistic approach to diabetes management. They are especially valued in communities where traditional practices and beliefs have a significant impact on health and wellness. Complementary treatments are an appealing option for people looking for cost-effective, culturally aligned care because they are affordable and accessible. However, a lack of scientific validation and potential scepticism from conventional medical practitioners may limit their widespread acceptance and integration into mainstream healthcare systems.

The suggestion is that a balanced approach to diabetes management, incorporating both contemporary and complementary treatments, can provide a comprehensive and patient-centred solution. This integrative approach respects individual preferences and cultural contexts while also improving the overall effectiveness and acceptability of treatment strategies. Healthcare systems can better address the diverse needs of diabetes patients by incorporating both scientific rigour and cultural sensitivity, resulting in better health outcomes and greater satisfaction.

Moving forward, it is critical to promote collaboration between conventional healthcare providers and complementary medicine practitioners to ensure that patients receive comprehensive and inclusive care. Policymakers and healthcare professionals should advocate for policies that support the incorporation of complementary treatments into traditional medical frameworks, encourage research to validate the efficacy of these treatments and ensure equitable access to a diverse range of therapeutic options. Finally, recognising and addressing the social consequences of various treatment approaches will result in a more inclusive, effective, and sustainable healthcare system for managing diabetes and other chronic conditions.

The South African government has implemented a variety of strategies through the National Department of Health, including the Integrated Chronic Disease Management Strategy. This initiative emphasises the importance of early detection, treatment, and management of chronic diseases, including diabetes. It is critical to raise awareness about diabetes’s risk factors and symptoms. Public campaigns can be launched to raise awareness about the importance of regular health screenings, particularly among high-risk populations such as those with a family history of diabetes or obesity.

Furthermore, encouraging the consumption of healthy foods and physical activity can be incorporated into public health messaging. Community health workers can be trained to disseminate information and promote lifestyle changes at the local level.

Diabetes management and prevention require a strong education component. Schools and workplaces can implement diabetes awareness programmes that emphasise nutrition and physical activity. Teaching children about healthy eating habits and the value of regular exercise can instil lifelong habits that lower their risk of developing diabetes. Furthermore, healthcare providers should have the necessary training to effectively educate patients about diabetes management, which includes blood sugar monitoring, dietary changes, and the importance of medication compliance. Providing culturally relevant educational materials can help to bridge the communication gap between healthcare providers and communities, making information more accessible and understandable.

We can create a more equitable healthcare landscape that respects and values the various approaches people take to their health and wellness by understanding the strengths and limitations of both modern and complementary treatments.

Acknowledgements

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Karishma Singh: Conceptualisation; Investigation; Methodology; Writing – original draft. Kuben Naidoo: Writing – review & editing. Abdulhakeem Sulyman: Writing – review & editing. All authors reviewed the article, contributed to the discussion of results, approved the final version for submission and publication, and take responsibility for the integrity of its findings.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

The authors confirm that the data supporting this study and its findings are available within the article and its listed references.

The views and opinions expressed in this article are those of the authors and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article’s results, findings, and content.

References