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Introduction: Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia due to defects in insulin secretion, insulin action, or both. It is one of the fastest-growing lifestyle disorders worldwide. Ayurveda describes Prameha as a broad group of urinary disorders, with Madhumeha closely resembling type 2 diabetes mellitus (T2DM). This review aims to integrate Ayurvedic concepts of Prameha with modern understanding and evaluate complementary management strategies. Methods: A comprehensive review was conducted using Ayurvedic classics (Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya), PubMed, Scopus, and Web of Science. Studies included were original research, reviews, and clinical trials (2000–2024) focusing on diabetes, Prameha, and integrative medicine. Exclusion criteria were case reports and non-peer-reviewed works. Results: Ayurveda describes Prameha as a Santarpanajanya Vyadhi (disease of overnutrition), primarily due to Kapha dosha aggravation, Medo dhatu dushti (fat tissue derangement), and Ojas kshaya (depletion of vital essence). Clinical features such as polyuria, turbidity of urine, and metabolic abnormalities correlate with diabetes mellitus. Ayurvedic management emphasizes Nidana parivarjana (removal of causative factors), Shodhana (detoxification, mainly Panchakarma), Shamana (pacifying therapies with herbs like Guduchi, Amalaki, Meshashringi, and Shilajit), and Rasayana (rejuvenation therapy). Modern medicine focuses on pharmacological therapies (insulin, metformin, SGLT2 inhibitors, GLP-1 receptor agonists), lifestyle interventions, and preventive strategies. Recent evidence supports the antidiabetic effects of several Ayurvedic herbs. Discussion: Ayurvedic concepts of Prameha and Madhumeha parallel modern understanding of insulin resistance, obesity, and metabolic syndrome. Integrative approaches, combining lifestyle correction, yoga, and selected Ayurvedic formulations with modern therapeutics, may enhance glycemic control, reduce complications, and improve quality of life. However, robust clinical trials are required for global acceptance. Conclusion: Prameha reflects an ancient understanding of diabetes mellitus. An integrative approach utilizing Ayurveda and modern medicine could provide effective, holistic, and sustainable solutions for diabetes management.

KEYWORDS: Ayurveda, Diabetes mellitus, Madhumeha, Prameha, Rasayana