Abstract

Herbal remedies remain widely used worldwide as adjuncts or alternatives for diabetes management. Many 
botanicals show promising glucose-lowering, insulin-sensitizing, anti-inflammatory and antioxidant effects in vitro, 
in animals and in small human trials. However, enthusiasm for phytomedicines is tempered by variable product 
quality, inconsistent clinical evidence, and growing reports of organ toxicity-particularly herb-induced liver injury 
(HILI), nephrotoxicity, and, less commonly, neurotoxic or hematologic adverse events. This review synthesizes 
current evidence on the efficacy of common antidiabetic herbs, highlights mechanisms by which herbs may both help 
and harm (glycemic modulation, antioxidant action, mitochondrial effects, xenobiotic metabolism), and surveys 
reported toxicities and their mechanistic bases. We emphasize three practical priorities for clinicians, researchers 
and policymakers: (1) rigorous clinical evaluation (well-designed RCTs with adequate duration and safety 
endpoints), (2) pharmacovigilance and pre-market quality controls to detect contaminants/adulterants and ensure 
dose consistency, and (3) patient-centered risk–benefit communication, particularly for people with hepatic or renal 
impairment. Finally, we outline research gaps-standardized extracts, herb–drug interaction studies, and shared 
registries for herbal adverse events-that are essential to safely integrate plant medicines into diabetes care.