Avocado (<i>Persea americana</i>) in diabetes management: a systematic review of preclinical evidence and its translational potential

Mary Olaoluwa Agunloye; Daniel. U. Owu; Olufunke Onaadepo; Felix Nnaemeka Ugwu; Edward Jjesero; Emmanuel Dembe Ssali; Ilemobayo Victor Fasogbon

doi:10.12688/f1000research.162807.1

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Systematic Review

Avocado (Persea americana) in diabetes management: a systematic review of preclinical evidence and its translational potential

[version 1; peer review: 1 approved with reservations, 1 not approved]

Mary Olaoluwa Agunloye ¹, Daniel. U. Owu¹, Olufunke Onaadepo¹, [...] Felix Nnaemeka Ugwu¹, Edward Jjesero¹, Emmanuel Dembe Ssali¹, Ilemobayo Victor Fasogbon²

Mary Olaoluwa Agunloye ¹, Daniel. U. Owu¹, [...] Olufunke Onaadepo¹, Felix Nnaemeka Ugwu¹, Edward Jjesero¹, Emmanuel Dembe Ssali¹, Ilemobayo Victor Fasogbon²

PUBLISHED 07 Apr 2025

Author details Author details

¹ Department of Physiology, Kampala International University - Western Campus, Bushenyi, Western Region, Uganda
² Department of Biochemistry, Kampala International University - Western Campus, Bushenyi, Western Region, Uganda

Mary Olaoluwa Agunloye
Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Daniel. U. Owu
Roles: Project Administration, Supervision, Writing – Review & Editing

Olufunke Onaadepo
Roles: Data Curation, Project Administration, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing

Felix Nnaemeka Ugwu
Roles: Formal Analysis, Supervision, Writing – Original Draft Preparation

Edward Jjesero
Roles: Data Curation, Formal Analysis, Writing – Review & Editing

Emmanuel Dembe Ssali
Roles: Formal Analysis, Validation, Writing – Original Draft Preparation

Ilemobayo Victor Fasogbon
Roles: Data Curation, Formal Analysis, Validation

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Diabetes remains a major health challenge in low- and middle-income countries like Uganda, where access to effective treatment is often limited. Avocado (Persea americana) has demonstrated antidiabetic potential in global preclinical studies, but research on its pharmacological benefits within Uganda’s healthcare context is scarce. This review synthesizes global evidence on avocado’s bioactive compounds and therapeutic effects, highlighting gaps that warrant further investigation.

Methods

A systematic search was conducted across PubMed, Scopus, and Web of Science to identify peer-reviewed English-language studies on avocado’s antidiabetic properties. Eligible studies included preclinical models and intervention studies. This review adheres to PRISMA 2020 guidelines. Data extraction and quality assessment were performed independently by two reviewers. Of the 266 articles initially identified, 45 met the inclusion criteria.

Results

Avocado extracts significantly improve metabolic markers, with 30 studies reporting statistically significant reductions in blood glucose levels (p < 0.05). The bioactive compounds modulate key diabetes-related pathways, suggesting a multi-target therapeutic approach. However, most evidence originates from global research, with limited studies conducted in African populations or within Uganda’s healthcare setting. While toxicity assessments indicate a favorable safety profile, challenges such as standardization of extraction methods, dosage optimization, and clinical validation persist.

Conclusion

Avocado demonstrates strong antidiabetic potential, but region-specific research is essential to validate its efficacy and practical application in Uganda. Strengthening local research efforts could bridge the gap between global evidence and Uganda’s healthcare needs, facilitating its evidence-based integration into traditional and modern diabetes treatment strategies.

Keywords

Avocado Extract, Persea americana, Diabetes Mellitus, Preclinical Studies, Translational Research, Bioactive Compounds, Uganda, Diabetes Therapy, Herbal Medicine

Corresponding author: Mary Olaoluwa Agunloye

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2025 Agunloye MO et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Agunloye MO, Owu DU, Onaadepo O et al. Avocado (Persea americana) in diabetes management: a systematic review of preclinical evidence and its translational potential [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2025, 14:404 (https://doi.org/10.12688/f1000research.162807.1) First published: 07 Apr 2025, 14:404 (https://doi.org/10.12688/f1000research.162807.1) Latest published: 07 Apr 2025, 14:404 (https://doi.org/10.12688/f1000research.162807.1)

Introduction

Diabetes mellitus is a condition marked by elevated blood sugar levels which may result from a structural issue, such as the failure of pancreatic beta cells to produce insulin or the reduced sensitivity of target cells to insulin.^1–3 It is a growing global health challenge, with sub-Saharan Africa (SSA) experiencing a rapid increase in type 2 prevalence (90-95% cases) due to lifestyle changes, urbanization, and genetic predisposition.⁴ The prevalence of diabetes mellitus across SSA is expected to increase from 15.9 million in 2017 to 40.7 million by 2045,⁵ with over two-thirds of cases remaining undiagnosed.⁶ Inadequate healthcare funding has resulted in poor diabetes care,⁷ while the disease contributes to both chronic conditions such as cardiovascular and kidney diseases,⁸ as well as infectious diseases like pneumonia and tuberculosis.⁹ As a lifelong condition affecting multiple organ systems, diabetes requires a comprehensive and resource-intensive approach for effective management.¹⁰

Mayega documented a diabetes prevalence rate of 7.4% in Uganda, while pre-diabetes was reported at 8.6%.¹¹ Additionally, the total incidence of type 2 diabetes in Kanugu district was reported to be 18.7% among tested patients in 2019.¹² Uganda, like many low- and middle-income countries, faces a rising diabetes burden, straining healthcare systems that often rely on costly pharmaceutical interventions. As a result, natural therapies derived from medicinal plants have gained interest as complementary or alternative strategies for diabetes management.

Avocado (Persea americana), a widely cultivated and consumed fruit in Uganda, has shown antidiabetic potential in global preclinical studies due to its bioactive compounds like flavonoids, polyphenols, and fatty acids. These compounds help regulate glucose metabolism, enhance insulin sensitivity, and reduce oxidative stress.^13–16 However, despite the widespread cultivation, abundance and consumption of avocado (Persea americana) in Uganda, its role in diabetes management remains underexplored, with limited awareness of its potential benefits. This review synthesizes existing evidence on avocado’s pharmacological effects on glycemic control and explores its translational relevance, particularly for populations with high avocado consumption, such as Uganda.

Methods

Search strategies

A structured and comprehensive search strategy was employed to identify relevant published articles on the antidiabetic efficacy of avocado (Persea americana) globally. The literature search was performed using electronic databases, including PubMed, Scopus, and Web of Science (WoS), without any restrictions on the publication year. The search terms used included “Persea americana” OR “Avocado *diabet*, OR *anti-diabet* as outlined in Table 1. To ensure quality and relevance, only peer-reviewed articles published in English were considered. The search strategy adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines for the article selection process.

Table 1. Articles search strategy.

Search	Strategy for databases
Scopus	Scopus Title, Abstract, and Keyword (TITLE-ABS-KEY) Search (“Persea americana” OR avocado) AND (diabet)
WoS	(“Persea americana” OR avocado) AND (diabet)
PubMed	(((Persea americana [Title/Abstract]) OR (avocado [Title/Abstract])) AND ((antidiabet[Title/Abstract]) OR (anti-diabet[Title/Abstract] OR (diabet*[Title/Abstract])) NOT (review [Publication Type])))

Eligibility criteria, and data extraction

Articles were selected based on the following inclusion criteria: preclinical studies investigating the use of avocado plant parts for diabetes treatment, with a specific focus on diabetes mellitus. Only peer-reviewed original research published in English was considered. Eligible studies had to report findings on avocado’s antidiabetic effects, including its impact on blood glucose levels, insulin sensitivity, oxidative stress, inflammation, and molecular mechanisms. Studies using validated extraction methods (aqueous, ethanol, methanol, etc.) and compound identification techniques (HPTLC, HPLC, GC-MS, etc.).

Exclusion criteria were defined to streamline the screening and selection process, ensuring the omission of studies that did not meet the specified conditions. Studies unrelated to avocado extracts or bioactive compounds in diabetes management or those lacking relevant anti-diabetic outcomes was excluded. Non-English publications, review articles, editorials, commentaries, book chapters, and conference summaries, duplicate publications and studies with ethical concerns or conflicts of interest was excluded. Also we excluded studies with poor methodology, unclear experimental design, or unreported/unreliable statistical significance.

Search results

A total of 266 articles were identified, with 72 from Web of Science (WoS), 136 from Scopus, and 58 from PubMed. The articles were uploaded to Rayyan, an online tool for systematic reviews, to facilitate screening and selection by two (2) independent reviewers. Rayyan detected 182 duplicate entries, leading to the removal of 114 articles, while 68 duplicates were manually resolved. After eliminating duplicates, 152 remaining articles were screened based on their titles and abstracts to exclude irrelevant studies. Full-text articles, were then assessed against the inclusion criteria, resulting in 45 studies being selected for final analysis as shown in Figure 1. The data reviewed in this study were extracted by 2 independent reviewers based on consensus. A descriptive synthesis was used to summarize preclinical studies on the antidiabetic potential of avocado (Persea americana), as meta-analysis was not feasible due to heterogeneity in study designs, models, and outcomes. All extracted data were organized, analyzed, and visualized using Microsoft Excel (2013 Version) through descriptive statistics, bar charts, pie charts, and tables. This method was chosen to enhance clarity and provide a comprehensive overview of the diverse findings across studies. Variations in dosage, extraction methods, and diabetes models were critically examined, and their implications for translational research and clinical applications were discussed.

Figure 1. Methodology flowchart.

Results

Figure 2 delineates the various extraction methods used in preclinical studies investigating the diabetic modulation potential of Persea americana. The results reveal that ethanolic extraction is the most frequently utilized method in reviewed studies, followed by aqueous extraction. This preference for ethanol may be due to its effectiveness in extracting a wide range of bioactive compounds with antidiabetic potential. These findings emphasize the crucial role of extraction techniques in influencing the bioavailability and therapeutic efficacy of avocado-derived extracts for diabetes management.

Figure 2. Extraction methods in studies.

Figure 3 presents the distribution of avocado (Persea americana) parts utilized in preclinical studies on diabetes modulation. The results show that the seed and leaves are the most commonly studied, indicating their potential as rich sources of bioactive compounds with antidiabetic effects. The fruit pulp and oil follow in usage, though they have been investigated to a lesser extent. These patterns reflect research priorities in phytochemical and pharmacological studies and may provide direction for future studies exploring the most effective avocado-derived extracts for diabetes management.

Figure 3. Avocado parts used in studies.

Table [2] (refer to extended data⁵⁸) summarizes the characteristics and sample details of the reviewed preclinical studies on the antidiabetic efficacy of avocado (Persea americana). It includes key information such as authors, publication year, study design, sample size, and plant parts used, providing insight into experimental methodologies and comparability. As shown in Table [2] (refer to extended data⁵⁸), most studies utilized in vivo models (Wistar rats, albino rats, Swiss Webster mice) or in vitro enzyme inhibition assays targeting α-amylase, α-glucosidase, and DPP-IV activity. Additionally, Goto-Kakizaki (GK) rats, a genetic model for type 2 diabetes, were used to assess hereditary influences.

Extended data Table [2] further reveals that diabetes was induced using streptozotocin (STZ) and alloxan, while some studies mimicked insulin resistance through high-fat and high-fructose diets. Fasting blood glucose (FBG) levels ranged from ~180 to 450 mg/dL, depending on the induction method. Moreover, studies reported organ damage (kidney, liver, pancreas), oxidative stress, lipid metabolism alterations, and insulin resistance, underscoring the metabolic impact of diabetes and the therapeutic potential of avocado-derived bioactives.

The extended data (Table 3) provides a comprehensive analysis of bioactive compounds, mechanisms of action, and toxicity profiles of avocado extracts. It identifies key phytochemicals, including flavonoids, phenolic acids, tannins, fatty acids (oleic acid, palmitic acid), phytosterols, and glycosides, with quantitative analysis performed using GC-MS and HPLC-MS/MS. Table [3] (refer to extended data⁵⁸) further details their mechanisms of action, such as adiponectin receptor activation, PI3K/Akt pathway modulation, α-amylase inhibition, and mitochondrial function enhancement. These compounds influence gene and protein expression, including the upregulation of insulin-related genes (PDX1, Ins1), reduction of inflammatory markers (TNF-α, IL-6), and enhancement of GLUT4 translocation.

Toxicity assessments indicate that most studies reported no significant toxicity (LD50 > 400–6000 mg/kg BW), though mild liver cell damage was observed in some extracts. Overall, the data reinforce avocado’s therapeutic potential in diabetes management and metabolic health, while highlighting the need for further safety evaluations and clinical validation.

Table [4] (refer to extended data⁵⁸) outlines the limitations and contextual relevance of studies investigating the antidiabetic properties of avocado (Persea americana) and its derivatives. While research highlights glucose-lowering effects, antioxidant activity, lipid regulation, and pancreatic protection, several methodological limitations persist. These include small sample sizes, lack of long-term toxicity assessments, limited mechanistic insights, and insufficient in vivo validation. Some studies suggest that avocado extracts aid in enzyme inhibition ( α-amylase, α-glucosidase), enhance mitochondrial function, and modulate insulin pathways, while others indicate potential benefits for diabetic nephropathy. This analysis helps identify research gaps and suggests directions for future studies to bridge preclinical findings with practical diabetes management strategies in the Ugandan context.

Table [5] (refer to extended data⁵⁸) presents extended data on various avocado extracts, their dosages, treatment durations, and effects in preclinical diabetes studies. Extracts such as methanolic, ethanolic, aqueous, hydroethanolic, and avocado oil were administered at varying concentrations and durations. Ethanolic and methanolic extracts significantly lowered fasting blood glucose (FBG), HbA1c levels, and oxidative stress, while avocado oil improved renal function, mitochondrial activity, and lipid metabolism. Some studies also reported β-cell regeneration, α-glucosidase and α-amylase inhibition, and protection against diabetic nephropathy. Furthermore, the table indicates whether the reported effects were statistically significant, providing insight into the reliability and strength of the findings. However, results varied with dosage, extraction method, and experimental model, with some studies indicating that higher doses were ineffective.

Discussion

This systematic review highlights key findings related to study design, extraction methods, dosage effectiveness, mechanistic insights, and the safety profile of avocado (Persea americana) in antidiabetic research. The majority of studies (30) employed in vivo animal models, emphasizing their physiological relevance, while 13 studies used in vitro approaches, primarily to investigate mechanistic pathways. A smaller subset (2 studies) combined both methods (invivo and invitro), enhancing the reliability of findings by providing cellular-level insights alongside whole-organism validation. Variations in extraction methods were evident, with ethanolic (12 studies) and aqueous extracts (10 studies) being the most frequently used due to their efficiency in preserving bioactive compounds. Other methods, such as methanolic (6 studies) and hydroalcoholic extractions, were also utilized, indicating ongoing efforts to optimize bioavailability and efficacy in diabetes treatment.

Dosage assessments revealed a wide range (0.01 mg/kg to 1000 mg/kg), with a median dosage of 50 mg/kg, suggesting a general consensus on effective dosing. Higher doses were likely explored for toxicity evaluation, while statistically significant effects (p < 0.05 in 30 studies) reinforce the antidiabetic potential of avocado-based extracts. Mechanistic studies identified bioactive compounds in 36 studies, which contribute to antidiabetic activity through multiple pathways, including glycemic control (insulin sensitivity and secretion), oxidative stress reduction (antioxidant effects), inflammatory modulation (cytokine regulation), and pancreatic β-cell protection. These findings underscore avocado’s potential as a multifaceted therapeutic option for diabetes management.

Toxicity evaluations conducted in 22 studies reported no significant adverse effects at commonly tested doses, supporting the safety of avocado-derived compounds. However, further long-term studies are necessary to establish safety at higher concentrations and prolonged exposure.

Future research, clinical implications and public health relevance

To effectively translate global findings into local applications, researchers should prioritize preclinical investigations to assess the efficacy, optimal dosages, and safety of avocado extracts under local conditions. While preclinical studies highlight the antidiabetic potential of avocado (Persea americana), further research is necessary to confirm its clinical relevance. Human trials remain limited, necessitating well-designed randomized controlled trials (RCTs) to validate efficacy, appropriate dosage, and long-term safety. Additionally, standardizing extraction methods is crucial to ensure consistency in bioactive compounds across studies.

Mechanistic research should also clarify how avocado influences insulin signaling, pancreatic β-cell function, and gut microbiota, which are critical pathways in diabetes management. Furthermore, dietary habits, genetic predispositions, and lifestyle factors may impact avocado’s effectiveness, warranting region-specific research. Given its widespread availability, especially in Uganda, integrating avocado into public health strategies could provide a cost-effective and accessible nutritional intervention for diabetes management.

If validated in clinical studies, avocado could serve as a natural adjunct therapy for glycemic control. Healthcare professionals, including nutritionists and physicians, may incorporate avocado consumption into evidence-based dietary guidelines for diabetes management. Moreover, policymakers could explore avocado-derived products as functional foods for diabetes prevention and treatment, contributing to affordable and sustainable healthcare solutions.

Limitations in the study review process

This review is constrained by its exclusive focus on preclinical studies, limiting its ability to directly translate findings to human applications. Publication bias may over-represent positive findings, while methodological variations in extraction techniques, dosages, and diabetes models pose challenges to comparability. Additionally, the predominance of global data restricts regional applicability, and language/database limitations may have led to the exclusion of relevant studies.

Conclusion

Study findings provide strong preclinical and translational evidence supporting the antidiabetic efficacy of avocado (Persea americana), demonstrating improvements in glycemic control, insulin sensitivity, and oxidative stress reduction. However, research in Uganda remains limited, with most findings derived from global research and few studies conducted in African populations or within Uganda’s unique dietary and environmental context. Given the country’s rising diabetes burden and the widespread availability of avocado, further investigation into its pharmacological potential is crucial. This study highlights preclinical and translational insights, emphasizing the need for further research on avocado’s therapeutic potential in Uganda’s healthcare system. Strengthening indigenous research could support evidence-based integration of avocado into diabetes management strategies, offering a cost-effective and sustainable intervention.

Declarations

Ethical approval

Not applicable (This review study involves the synthesis and analysis of existing literature and does not include new human or animal research. All reviewed studies were conducted in accordance with ethical standards for human and animal research).

Consent for publication

Not applicable.

Contribution of authors

AOM contributed to the conceptualization, OUD, OO, UNF, JE, FVI, SDE and AOM contributed to screening, data extraction, data analysis, proofreading, and data arrangement. AOM, OO and OUD contributed to final draft.

Data availability

No data are associated with this article.

Extended data

Open Science Framework: Avocado (Persea americana) in diabetes management: a systematic review of preclinical evidence and its translational potential. Doi: https://osf.io/r537z/.⁵⁸

This project contains the following extended data:

• Supplementary data.Table 2.docx
• Supplementary data.Table 3.docx
• Supplementary data.Table 4.docx
• Supplementary data.Table 5.docx

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

Reporting guidelines

Open Science Framework: PRISMA checklist and flowchart for “Avocado (Persea americana) in diabetes management: a systematic review of preclinical evidence and its translational potential”. Doi: https://doi.org/10.17605/OSF.IO/92Y3A (https://osf.io/r537z/).⁵⁸

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

Acknowledgements

Not applicable.

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