Banshi Saboo, Ameya Joshi, Subir Chandra Swar, Mahesh D M, Anantharaman Ramakrishnan, Apoorva Hajirnis, Suhas Khaire, Subrata Chakrabarti, Sreedevi Patnala, Sattik Siddhanta, Virendra A Patil, Parthasarathy Balasubramanian, Uthra Subash Chandra Bose, Sriram Kalangani Mohan, Nandan Arun Joshi, Sourabh Bharat Sonawale
A distinct "South Asian phenotype" and unhealthy dietary patterns contribute to the high burden of type 2 diabetes mellitus (T2DM) in India, highlighting the need for context-specific nutritional management. Five regional advisory board meetings were conducted to gather expert perspectives on the unique epidemiology of T2DM and key aspects of nutritional management, including optimal dietary practices and the role of high-protein, high-fiber (HPHF) supplements or meal replacements. A total of 60 experts attended the meetings. During each meeting, an optional multiple-choice poll was administered as part of the discussion. Expert perspectives were derived from optional poll responses and discussions informed by scientific evidence and participants' clinical experience. High carbohydrate and low protein intake, insulin resistance, central obesity, suboptimal muscle mass, and genetic predisposition characterize Indian patients with diabetes. Recognizing this phenotype is essential for providing tailored nutritional interventions. Key assessments to facilitate nutritional interventions include anthropometry (weight, body mass index, and waist circumference), lipid profile, and 24-hour dietary recalls. Experts emphasized that customized nutrition plans should be developed based on individual nutritional status, clinical profile, and dietary preferences. Dietary strategies should emphasize increased consumption of complex carbohydrates, high-fiber foods, and protein. The high burden of "diabesity" underscores the need for nutritional interventions addressing both glycemic control and weight management, including the appropriate use of meal replacement strategies. Protein and fiber are key nutrients in diabetes management. While dietary sources should be prioritized, experts noted that low-glycemic index, HPHF supplements/replacements may be considered for patients with overweight/obesity, poor nutrition intake, weakness or fatigue, or uncontrolled hyperglycemia. However, their limited use in clinical practice highlights the need for further research to evaluate their indications for use, effectiveness, safety, implementation, cost considerations, and long-term outcomes. This expert opinion highlights the unique epidemiology of T2DM in India and provides context-specific, evidence-informed insights to support nutritional management strategies. These perspectives are derived from advisory board discussions and should be interpreted as expert opinion rather than systematic evidence synthesis or formal guideline recommendations.