Diabetes mellitus (DM) is a chronic metabolic disorder that has become a major global health concern. Currently, it affects approximately 537 million people worldwide, with projections suggesting an increase to 643 million by 2030 and 783 million by 2045 (Kiran et al., 2024). This rising prevalence underscores the need for ongoing research and intervention strategies (Alam et al., 2021, Mukhtar et al., 2020). Uncontrolled diabetes can result in hyperglycaemia and severe complications such as diabetic nephropathy, retinopathy, neuropathy, and cardiovascular diseases (Poonoosamy et al., 2023).

Standard treatments for diabetes include medications such as glinides, biguanides (e.g., Metformin), sulfonylureas, and insulin therapy. While effective, these drugs are often associated with side effects such as weight gain, anaemia, renal impairment, and gastrointestinal disturbances (Morris, 2023). As a result, there is a growing interest in natural alternatives with safer profiles.

Moringa oleifera, a medicinal plant from the Moringaceae family, is widely recognised for its therapeutic potential. Various parts of the plant, including leaves, seeds, and roots, contain bioactive compounds such as flavonoids, polyphenols, and alkaloids, which contribute to its antidiabetic, anti-inflammatory, and antioxidant properties (Tariq et al., 2021, Shabnam et al., 2023). M. oleifera, a plant also known as the tree of life is native to the tropics and sub-Himalayan areas of India, Pakistan, Bangladesh, and Afghanistan. The immature green pods, also known as drumsticks, are consumed in different ways, such as cooking the pods (as with green beans) or preparing the leaves like spinach. Along with glycemic control in diabetes, as well as useful to treat asthma, hyperlipidaemia, hypertension, hormone disorders, and gastrointestinal disorders (Jikah and Edo, 2023).

The hypoglycemic effects of Moringa have been linked to its ability to enhance insulin secretion, improve glucose uptake, and reduce oxidative stress (Singh et al., 2020). Based on human studies, the plant has been proposed to decrease glucose levels by increasing insulin secretion and sensitivity and by inhibiting amylase and glucosidase activities (Abdelazim et al., 2024). Proven by some studies, additional proposed mechanisms of action include increased glucose uptake in the muscle and liver, inhibition of glucose uptake in the intestine, and decreased gluconeogenesis in the liver (Papuc et al., 2021). The leaves are widely used as a vegetable, condiment and in salads. M. oleifera leaves are non-toxic (Ganjayi et al., 2023).

Despite promising preliminary data, clinical research on the adjunctive use of Moringa with standard antidiabetic drugs remains limited. This study aims to evaluate the synergistic effects of M. oleifera as an adjunct therapy to Metformin in improving glycemic control in type 2 diabetes mellitus (T2DM) patients.