Adjunct use of honey in diabetes mellitus: A consensus or conundrum?

Background: Honey is being used in Complementary and Alternative Medicine, especially in Indian Ayurvedic Medicine, as an adjuvant and supplement in diabetes mellitus treatment since immemorial times. In recent times, the use of honey has experienced a renewed interest in the context of diabetes treatment because of the rise in the accessibility of evidence-based pharmacological and clinical findings, signifying its health benefits. Scope and approach: There are differential opinions regarding the traditional use of honey in diabetes mellitus. The present review highlights various research propositions, hoisted issues, and misconceptions regarding the effects of honey in diabetes management and presents current challenges and future perspectives. A comprehensive critical review was performed by probing the traditional antidiabetic claims of honey, considering published reports in online databases. Key findings and conclusions: A total of 20 pre-clinical and 25 clinical studies investigated the antidiabetic effect of honey. Though in vivo studies are still limited, the findings reinforce the multi-targeted antidiabetic effect of honey, exerting antioxidant, nutritional, antihyperglycemic, immunomodulatory, anti-inflammatory, wound-healing, antihypertensive, hypolipidemic, and hypoglycaemic activities. Preclinical and clinical evidence suggests that honey may possess multi-faceted and adjunct effects to accomplish a better glycaemic control, ameliorate several metabolic derangements, and mitigate oxidative stress-evoked diabetic problems. Nevertheless, the findings remain inconclusive due to poor study designs and other limitations (e.g. short duration, few participants, the difference in type of study participants, varied honey sources, and administered doses). Overall, there is a significant gap in knowledge, and hence, carefully planned, detailed in vitro, in vivo, and clinical studies are warranted to reach better conclusions.