Abstract Background and aim Fenugreek is a herb that is widely used in cooking and as a traditional medicine for diabetes in Asia. It has been shown to acutely lower postprandial glucose levels, but the long-term effect on glycemia remains uncertain. We systematically reviewed clinical trials of the effect of fenugreek intake on markers of glucose homeostasis. Methods PubMed, SCOPUS, the Cochrane Trials Registry, Web of Science, and BIOSIS were searched up to 29 Nov 2013 for trials of at least 1 week duration comparing intake of fenugreek seeds with a control intervention. Data on change in fasting blood glucose, 2 hour postload glucose, and HbA1c were pooled using random-effects models. Results A total of 10 trials were identified. Fenugreek significantly changed fasting blood glucose by -0.96 mmol/l (95% CI: -1.52, -0.40; I 2  = 80%; 10 trials), 2 hour postload glucose by -2.19 mmol/l (95% CI: -3.19, -1.19; I 2  = 71%; 7 trials) and HbA1c by -0.85% (95% CI: -1.49%, -0.22%; I 2  = 0%; 3 trials) as compared with control interventions. The considerable heterogeneity in study results was partly explained by diabetes status and dose: significant effects on fasting and 2 hr glucose were only found for studies that administered medium or high doses of fenugreek in persons with diabetes. Most of the trials were of low methodological quality. Conclusions Results from clinical trials support beneficial effects of fenugreek seeds on glycemic control in persons with diabetes. However, trials with higher methodology quality using a well characterized fenugreek preparation of sufficient dose are needed to provide more conclusive evidence.