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Objective To evaluate and synthesize the evidence on the effect of Ayurvedic therapies for diabetes mellitus. Design Systematic review of trials. Measurements and main results We found no study that assessed Ayurvedic as a system of care. Botanical therapy was by far the most commonly studied Ayurvedic treatment. Herbs were studied either singly or as formulas. In all, 993 titles in Western computerized databases and 318 titles identified by hand-searching journals in India were examined, yielding 54 articles reporting the results of 62 studies. The most-studied herbs were G sylvestre, C indica, fenugreek, and Eugenia jambolana. A number of herbal formulas were tested, but Ayush-82 and D-400 were most often studied. Thirty-five of the studies included came from the Western literature, 27 from the Indian. Seven were randomized controlled trials (RCTs) and 10 controlled clinical trials (CCTs) or natural experiments. Twenty-two studies went on to further analysis based on a set of criteria. Of these, 10 were RCTs, CCTs, or natural experiments, 12 were case series or cohort studies. There is evidence to suggest that the herbs C indica, holy basil, fenugreek, and G sylvestre, and the herbal formulas Ayush-82 and D-400 have a glucose-lowering effect and deserve further study. Evidence of effectiveness of several other herbs is less extensive (C tamala, E jambolana, and Momordica charantia). Conclusions There is heterogeneity in the available literature on Ayurvedic treatment for diabetes. Most studies test herbal therapy. Heterogeneity exists in the herbs and formulas tested (more than 44 different interventions identified) and in the method of their preparation. Despite these limitations, there are sufficient data for several herbs or herbal formulas to warrant further studies. [ABSTRACT FROM AUTHOR]