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Background: Prameha is an Ayurvedic syndrome that encompasses clinical conditions involved in obesity, prediabetes, diabetes mellitus and metabolic syndrome, whereas Madhumeha is a subtype that is often correlated with diabetes mellitus. Objective: To review the classical concept of Prameha and Madhumeha, its correlation with diabetes, and the evidence for Ayurvedic and Panchakarma-based interventions. Methods: Narrative review based on a PubMed search and classical texts. Findings: Conceptual reviews describe 20 subtypes of Prameha with Kapha predominance and relate subtypes to type 1 and type 2 diabetes, although a critical analysis argues that equating Madhumeha with diabetes mellitus is problematic. In 56 patients with Madhumeha, Ayurvedic diet and lifestyle modification was followed by significant improvement in plasma glucose and HbA1c, without a control group. In a randomized trial of diabetic retinopathy, an Ayurvedic protocol that included mild Virechana and Nasya improved fasting blood sugar and serum cholesterol but not HbA1c or postprandial sugar relative to conservative care. A case report described leech therapy within integrative management of a diabetic foot ulcer. Controlled trials of Panchakarma in diabetes itself were not identified in the sources retrieved. Conclusion: The conceptual literature is rich, but direct evidence on Panchakarma in diabetes is sparse. Well-designed trials with glycaemic endpoints are a research priority.