Increasing quality and quantity of dietary protein may help combat diabetes epidemic in India: JAPI

"Increased intake of protein, preferably through dietary sources to meet the requirement, and when needed using diabetes-specific protein supplements (DSPS), is recommended in the prevention and control of type 2 diabetes (T2D)," the researchers wrote.

A 5–10% increase in protein energy over and above the current intake, if possible, bringing it up to 19–20% could help flatten the diabetes epidemic in India, the article stated.

Prediabetes, obesity, and type 2 diabetes pose a triple burden in India. About two-thirds of patients with diabetes in India are reported to have suboptimal glycemic, blood pressure (BP), and lipid control. Medical nutrition therapy (MNT) in diabetes has stressed the amount and type of carbohydrates for years. However, there is a need to focus on protein, an important macronutrient in diabetes management, especially in India, where its consumption is lower than the recommendations provided by most guidelines.

Against the above background, an expert committee led by Viswanathan Mohan, Chairman, of Dr Mohan’s Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), attempted to review the role of dietary protein in type 2 diabetes management, arrive at a consensus on the significance of increasing dietary protein for various benefits, and offer practical guidance on ways to improve protein intake among Indians.

The expert committee comprised ten endocrinologists and diabetologists, one nephrologist, and three registered dietitians representing four zones of India. An in-depth review of literature in the Indian context was performed, a draft document was shared with the expert committee, and their views were incorporated into the same.

Then, the expert committee assembled virtually to deliberate on several aspects of the role of protein in T2D management. The experts from various specialities provided valuable suggestions and inputs from their extensive personal clinical experience and research work. After all this, they reached a consensus on the role and significance of protein in managing type 2 diabetes and its complications in India.

Key takeaways from the study:

• There is abundant evidence that medical nutrition therapy is essential for the prevention and management of T2DM and its complications.
• Experts agree that increasing protein intake offers myriad health benefits, namely reducing glycemic variability, increasing insulin sensitivity, improving glycemic control, improving lipid profile and immunity, and helping in weight management and preservation of muscle mass in PWD.
• The expert committee suggested aiming for an increase in protein intake by at least 5–10% of the current intake instead of carbohydrates in PWD.
• Experts also highlighted the need for more data quantifying the unmet protein needs in the Indian PWD, especially among vegetarians.
• Randomized controlled trials to study the effect of protein in diabetes complications such as cardiovascular disease (CVD) and diabetic kidney disease (DKD) and comorbid conditions such as sarcopenia among the Indian population are also warranted.
• Diabetes-specific protein supplements (DSPS) can be advised in conditions where dietary sources are unable to meet the increased protein requirements.
• A 5–10% increase in protein energy over and above the current intake, if possible, bringing it up to 19–20%, could help flatten the diabetes epidemic in India.
• Individuals with T2DM in India are required to increase their protein intake both in terms of quantity and quality and simultaneously reduce their carbohydrate intake.

"Adequate protein in the diet of patients with diabetes is crucial for T2DM management," the expert committee wrote.

They added, "Targeting an increment of 5–10% of protein energy instead of carbohydrates in Indian PWD could ensure significant positive health outcomes such as improved glycemic control, reduced glycemic variability, insulin sensitivity, and lipid profile, immunity, and help in weight management and preservation of muscle mass apart from preventing diabetes."

In conclusion, the expert committee recommended increasing the quality and quantity of protein, preferably through dietary sources or where needed through DSPS for patients with diabetes.

Reference:

Mohan V, Misra A, Bhansali A, et al. Role and Significance of Dietary Protein in the Management of Type 2 Diabetes and Its Complications in India: An Expert Opinion. J Assoc Physicians India 2023;71(12):36–46.