A Comprehensive Review of Traditional Antidiabetic Plants Used for Diabetes Management in South Africa

In the wake of a global resurgence in complementary and alternative medicine, South African flora stands out for its wealth of species long employed in traditional treatments for diabetes. This review evaluates scientific advances in the anti-diabetic potential of traditional medicinal plants harvested in South Africa. Four electronic databases (Scopus, PubMed, Web of Science and African Index Medicus) were exhaustively searched up to February 2025. A total of 74 medicinal species across 21 botanical families were identified for their antidiabetic potential, notably Moraceae (23.25%), Fabaceae (16.27%) and Asteraceae (6.97%). Leaves constituted the most frequently used plant material (51.21%), followed by bark (21.95%), and extractions predominantly employed acetone (43.58%) or water (28.20%). In vitro assays revealed substantial inhibition of key enzymes, including yeast α-glucosidase, α-amylase, pancreatic lipase, and glucose 6-phosphatase. Meanwhile, in vivo studies (n = 6) demonstrated significant reductions in glycaemia, improvements in insulin sensitivity, attenuated protein glycation and mitigation of hepatic and renal histopathological damage. The principal mechanisms elucidated involve modulation of glucose intake, inulinomimetic enhancement, and protection and regeneration of pancreatic β cells. The most noteworthy species are Aloe ferox, Artemisia afra, Cassia abbreviata, Croton gratissimus, Erythrina lysistemon, Ficus lutea, Garcinia livingstonei, Psidium x durbanensis, Sutherlandia frutescens and Terminalia sericea.