Published Oct 05, 2026 | 7:00 AM ⚊ Updated Oct 05, 2026 | 7:00 AM
In an expert poll, 82 percent identified high carbohydrate intake as a key characteristic of diabetes in Indians.
Synopsis: An expert opinion involving 60 diabetes specialists says that no more than one in four patients with diabetes sustain dietary recommendations for six months. Experts highlighted India’s high carbohydrate intake, low protein consumption and distinct metabolic profile, calling for personalised nutrition plans, dietitian support and sustained lifestyle counselling to improve adherence.
No more than one in four patients with diabetes adhere to dietary recommendations for at least six months, according to an expert opinion involving 60 diabetes and endocrinology specialists, highlighting the difficulty of sustaining dietary changes in diabetes care in India.
The experts said the challenge is not simply a lack of awareness about what people with diabetes should eat, but also the difficulty of maintaining diet changes over the long term. They called for personalised nutrition plans, regular follow-up and greater involvement of dietitians to improve adherence.
The expert opinion, published in Diabetes, Metabolic Syndrome and Obesity, is based on five regional advisory board meetings held in Kolkata, Chennai, Bengaluru, Mumbai and Hyderabad between October 2023 and February 2024. The meetings brought together 60 diabetologists and endocrinologists with 15 to 35 years of clinical experience.
“Most experts stated that ≤25 percent of their patients adhered to dietary recommendations for at least 6 months,” the authors wrote.
They say the fix lies in sustained support, not one-off advice.
“A team of dietitians should work closely with patients to provide tailor-made meal plans, offer dedicated nutrition and lifestyle counseling, and maintain routine follow-ups at regular intervals,” the paper states.
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The experts said Indian patients with type 2 diabetes have a distinct metabolic and dietary profile, often characterised by high carbohydrate intake, poor protein intake, central obesity, insulin resistance and low lean muscle mass.
In an expert poll, 82 percent identified high carbohydrate intake as a key characteristic of diabetes in Indians. This was followed by central obesity at 78 percent, insulin resistance at 76 percent, poor protein intake at 75 percent and poor lean muscle mass at 69 percent.
They added that poor protein intake and low lean muscle mass “suggest that dietary imbalances and unfavorable body composition play crucial roles in the pathophysiology of diabetes in Indians.”
The paper also points to the so-called South Asian phenotype, where people tend to develop type 2 diabetes at a younger age and at a lower BMI than White Europeans. South Asians can have higher body fat, particularly abdominal, visceral and liver fat, even at a relatively low or normal BMI.
“South Asians tend to develop T2DM at a younger age (almost a decade earlier) and at a lower BMI compared with their White counterparts,” the paper notes.
This means relying on BMI alone may not fully capture metabolic risk in Indian patients, the paper notes.
Data from the ICMR-INDIAB survey cited in the paper showed that carbohydrates accounted for 62.3 percent of total daily energy intake among Indian adults.
The dietary pattern was dominated by lower-quality carbohydrates, including added sugars, milled grains and refined cereals. Protein contributed only 12 percent of total daily energy intake.
The disparity was also seen in the quality of protein intake. The paper cited ICMR-National Institute of Nutrition data showing that only 5 percent of the rural population and 18 percent of the urban population consumed recommended levels of good-quality protein.
Among people with diabetes, the gap was even more pronounced. One study cited by the authors found that only 14.8 percent met their daily protein requirement, while just 21.2 percent met their daily fibre requirement.
The authors said this combination of high carbohydrate intake and inadequate protein and fibre makes nutritional management particularly important for Indian patients.
The experts recommended moving away from generic diet charts and instead tailoring nutrition plans to an individual’s clinical profile, nutritional status, food preferences, cultural and religious practices and socioeconomic circumstances.
The authors say current tools fail on this count.
“Customized diet charts and personalized nutritional plans should be an integral part of the patient’s healthcare journey. However, current regional diet charts lack this specificity,” they wrote.
The recommended dietary pattern includes more complex carbohydrates, fibre-rich foods, pulses, legumes, vegetables, whole fruits, nuts and seeds and adequate protein. Refined grains, added sugars, fried foods and processed foods should be limited.
The experts also recommended assessing patients beyond blood glucose measurements. Weight, BMI, waist circumference, lipid profile and dietary intake should be considered when developing nutritional interventions.
In the advisory poll, 81 percent of experts said they assessed BMI and lipid profiles, 75 percent assessed weight and 62 percent used a 24-hour dietary recall. Only 34 percent said they assessed fat mass or muscle mass.
The experts also highlighted the overlap between diabetes and obesity, often referred to as “diabesity”.
“Despite the high burden of diabesity, the use of partial or complete meal replacements remains relatively limited in clinical practice,” the paper states.
The paper says weight management should be addressed alongside blood glucose control. A weight loss of 5-7 percent can improve glycaemic control, blood pressure and lipid profiles, while sustained weight loss of more than 10 percent may be associated with disease modification or remission.
The experts recommended calorie awareness, portion control, physical activity and behavioural counselling, along with diets containing adequate protein and fibre and fewer refined carbohydrates.
The paper also examined high-protein, high-fibre supplements and diabetes-specific nutrition formulas.
The experts said these products may be considered for selected patients, particularly those with poor nutritional intake (64 percent), overweight or obesity (54 percent), weakness or fatigue (42 percent) or uncontrolled hyperglycaemia despite medication (40 percent).
“Despite the high burden of diabesity, the use of partial or complete meal replacements remains relatively limited in clinical practice,” the paper states.
However, the experts stressed that food-based sources of protein and fibre should be prioritised. Supplements should be considered after an individual nutritional assessment and used under medical supervision. They should also be prescribed cautiously in patients with kidney disease.
The paper cites small Indian trials in which high-protein, high-fibre supplements were associated with improvements in HbA1c, fasting glucose and HDL cholesterol over 24 weeks. But the authors said larger studies are needed to establish their long-term effectiveness, safety, affordability and feasibility in India.
(Edited by Dese Gowda)
