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Development process of a clinical guideline to manage type 2 diabetes in adults by Ayurvedic practitioners

Chattopadhyay, Kaushik; Kapoor, Nitin; Heinrich, Michael; Mitra, Achintya; Mittal, Madhukar; Lewis, Sarah Anne; Greenfield, Sheila Margaret; Mukherjee, Shyamalendu; Pischel, Ivo; Jeemon, Panniyammakal; Tandon, Nikhil; Kinra, Sanjay; Biswas, Tuhin Kanti; Leonardi-Bee, Jo


Nitin Kapoor

Michael Heinrich

Achintya Mitra

Madhukar Mittal

Sheila Margaret Greenfield

Shyamalendu Mukherjee

Ivo Pischel

Panniyammakal Jeemon

Nikhil Tandon

Sanjay Kinra

Tuhin Kanti Biswas

Professor of Medical Statistics and Epidemiology


Background: Type 2 diabetes mellitus (T2DM), a common chronic health condition, has major health and socioeconomic consequences. In the Indian subcontinent, it is a health condition for which individuals commonly consult Ayurvedic (traditional medical system) practitioners and use their medicines. However, to date, a good quality T2DM clinical guideline for Ayurvedic practitioners, grounded on the best available scientific evidence, is not available. Therefore, the study aimed to systematically develop a clinical guideline for Ayurvedic practitioners to manage T2DM in adults.

Methods: The development work was guided by the UK’s National Institute for Health and Care Excellence (NICE) manual for developing guidelines, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. First, a comprehensive systematic review was conducted which evaluated Ayurvedic medicines’ effectiveness and safety in managing T2DM. In addition, the GRADE approach was used for assessing the certainty of the findings. Next, using the GRADE approach, the Evidence-to-Decision framework was developed, and we focused on glycemic control and adverse events. Subsequently, based on the Evidence-to-Decision framework, a Guideline Development Group of 17 international members made recommendations on Ayurvedic medicines’ effectiveness and safety in T2DM. These recommendations formed the basis of the clinical guideline, and additional generic content and recommendations were adapted from the T2DM Clinical Knowledge Summaries of the Clarity Informatics (UK). The feedback given by the Guideline Development Group on the draft version was used to amend and finalize the clinical guideline.

Results: A clinical guideline for managing T2DM in adults by Ayurvedic practitioners was developed, which focuses on how practitioners can provide appropriate care, education, and support for people with T2DM (and their carers and family). The clinical guideline provides information on T2DM, such as its definition, risk factors, prevalence, prognosis, and complications; how it should be diagnosed and managed through lifestyle changes like diet and physical activity and Ayurvedic medicines; how the acute and chronic complications of T2DM should be detected and managed (including referral to specialists); and advice on topics like driving, work, and fasting including during religious/socio-cultural festivals.

Conclusion: We systematically developed a clinical guideline for Ayurvedic practitioners to manage T2DM in adults.


Chattopadhyay, K., Kapoor, N., Heinrich, M., Mitra, A., Mittal, M., Lewis, S. A., …Leonardi-Bee, J. (2023). Development process of a clinical guideline to manage type 2 diabetes in adults by Ayurvedic practitioners. Frontiers in Medicine, 10,

Journal Article Type Article
Acceptance Date Jan 12, 2023
Online Publication Date Jan 30, 2023
Publication Date Jan 30, 2023
Deposit Date Jan 16, 2023
Publicly Available Date Jan 30, 2023
Journal Frontiers in Medicine
Electronic ISSN 2296-858X
Publisher Frontiers Media
Peer Reviewed Peer Reviewed
Volume 10
Keywords Development, clinical guideline, type 2 diabetes mellitus, Ayurveda, management
Public URL
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