Introduction

Type II Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by progressive insulin resistance and impaired insulin secretion. Its global prevalence is increasing at an alarming rate, with an estimated 700 million individuals expected to be affected by 2045.^[1] Among the various comorbidities associated with T2DM, Non-Alcoholic Fatty Liver Disease (NAFLD) is highly prevalent, impacting approximately 70% of individuals with diabetes.^[2] NAFLD not only represents hepatic involvement in metabolic syndrome but also serves as a strong predictor of cardiovascular disease and all-cause mortality.^[3] Despite its clinical significance, NAFLD remains underdiagnosed and undertreated in standard diabetes care.

Conventional management of T2DM typically involves long-term pharmacotherapy focused on glycemic control rather than addressing the underlying metabolic dysfunction.^[4] However, emerging evidence suggests that sustained lifestyle modification, particularly through weight loss and calorie restriction, can induce diabetes remission. For instance, the DiRECT trial demonstrated that a structured, low-calorie diet delivered through primary care could result in sustained diabetes remission and hepatic improvement over two years.^[5] Similarly, Ayurvedic medicine, which emphasizes a holistic view of health and disease, offers non-pharmacological options such as Panchakarma for detoxification, stress reduction, and metabolic restoration.^[6,7] These traditional therapies are increasingly being validated by modern research and are considered complementary to conventional management.

Integrative approaches like Panchsutri Reversal Therapy incorporate the principles of Ayurveda and modern medicine, combining: Panchakarma, calorie-restricted diet, continuous health monitoring, drug tapering, and stress management. Such multidisciplinary interventions are in alignment with newer paradigms in chronic disease care, which emphasize root-cause treatment and sustainable remission rather than symptom suppression.^[8] Mechanistically, these benefits can be explained by the twin cycle hypothesis, which describes how ectopic fat in the liver and pancreas drives insulin resistance and how its reduction can lead to diabetes reversal.^[9]

Centripetal Oleation: Neem oil and Abhyanga oil (Til Tail) were used to improve peripheral circulation, reduce inflammation, and enhance skin health. Essential oils like lavender and rose were incorporated for their anxiolytic and antihypertensive properties. Sessions lasted 20 minutes.

Thermal Vasodilation: Dashamoola Kwath was administered for 15–20 minutes to help sweating, reduce swelling, and improve toxin elimination.

Per Rectal Herbal Decoction Therapy: Herbal preparations such as GDY Kwath (containing Gudmar, Daruharidra, and Yashtimadhu) and G.H.A Kadha were administered for 10 minutes. These help to producing insulin, heal the cells that making insulin, and keep the heart and blood vessels healthy.

4. Ayurvedic medication:

Oral administration of the following formulations was given below.

Guduchi: Rasayan, antioxidant, antidiabetic; protects liver and cardiovascular health.

Meshshrungi: Helps repair and grow the cells that making insulin, enhances producing insulin, reducing glucose absorption.

Amalaki: Helps the body use insulin better and protects the cells from damage caused by toxins.

Haridra: Anti-inflammatory, stimulate cells, reduces diabetic symptoms.

Daruharidra: Antihyperglycemic, reduces insulin resistance, supports lipid metabolism.

Ashwagandha: Antioxidant, activating immune System; supports nervous and musculoskeletal systems.

5. Clinical monitoring:

Clinical parameters including HbA1c, eGFR, Anti-TPO, and blood pressure with ABPM were monitored to evaluate the progress. Regular laboratory testing supported the efficacy of the integrative interventions.

Study endpoints and data collection

Primary endpoint was diabetes reversal, normalised of HbA1c & oral glucose tolerance test (GTT) results in absence of medication-based intervention.

Discussion

This case report highlights the potential for complete reversal of Type II Diabetes Mellitus (T2DM) and resolution of Grade II fatty liver disease through Panchsutri Reversal Therapy, an integrative, non-drug therapies approach rooted in Ayurvedic and lifestyle medicine. T2DM is a growing global epidemic, with projections estimating it will affect over 700 million people by 2045.^[1] Non-alcoholic fatty liver disease (NAFLD), a frequent comorbidity of T2DM, is seen in up to 70% of diabetic individuals and serves as both a hepatic manifestation and an independent risk factor for cardiovascular disease and metabolic syndrome.^[2,3] Conventional medical management largely emphasizes pharmacological glycemic control rather than disease reversal, often leading to ongoing medication dependency without addressing underlying pathophysiology.^[4] In contrast, recent studies such as the Direct trial have demonstrated that intensive lifestyle interventions - including calorie restriction and sustained weight loss - can lead to diabetes remission and hepatic recovery.^[5] These findings are echoed by evidence supporting Ayurvedic detoxification therapies like Panchakarma, which have shown efficacy in improving metabolic health and insulin sensitivity.^[6,7] Additionally, the patient’s complete discontinuation of antidiabetic medications while maintaining glycemic control is consistent with outcomes from structured nutritional therapy trials, which emphasize the viability of medication-free management through lifestyle modification.^[8] The improvement in hepatic condition from Grade II fatty liver to “no significant anomaly” in this patient corresponds with the twin cycle hypothesis, which suggests that reducing ectopic fat from the liver and pancreas can reverse insulin resistance and T2DM progression.^[9] The resolution of neuropathic symptoms, improved gastrointestinal function, and better sleep quality further reflect the holistic benefits of integrative care. Continuous monitoring, stress management, and diet modification - core components of Panchsutri protocol - align with recommendations for sustained remission and patient empowerment in modern integrative medicine.^[10,11] Although this is a single-patient case and lacks the statistical power of a large trial, the comprehensive and sustained improvements support the need for further research into similar integrative models to manage and potentially reverse chronic metabolic diseases.

After Treatment