Purpose <p>Quality of life (QoL) in type 2 diabetes mellitus (T2DM) is frequently impaired by disease-related complications and symptoms. Aromatherapy has been proposed as a non-pharmacological means of improving QoL. This review evaluates randomized controlled trials (RCTs) of aromatherapy and QoL in adults with T2DM experiencing diabetes-related complications.</p> Methods <p>The review was prospectively registered in PROSPERO (CRD42024625423) and reported according to PRISMA. Web of Science, PubMed, Scopus, CINAHL, Google Scholar and the Cochrane Library were searched between December 2024 and January 2025. Eligibility criteria followed the PICOS framework, and full database-specific search strings are reported. Two reviewers independently performed study selection, data extraction and quality appraisal using the Joanna Briggs Institute (JBI) checklist for RCTs. Owing to heterogeneity, the data were synthesized narratively.</p> Results <p>Four RCTs comprising 293 randomized participants were included; three enrolled patients with diabetic peripheral neuropathic pain and one patients with insomnia. Aromatherapy was delivered by massage in three trials and by inhalation in one. JBI scores ranged from 9 to 12 of 13 (three high, one moderate quality). Randomization, baseline comparability and analysis were adequate throughout, whereas allocation concealment was unclear in three trials and blinding was incomplete in the massage trials. All four trials reported significant QoL improvement.</p> Conclusion <p>Aromatherapy may improve QoL in complicated T2DM, but the evidence is limited by few small trials and by susceptibility to performance and detection bias. Adequately powered, registered, placebo-controlled RCTs with concealed allocation and blinded outcome assessment are needed.</p>