Nutritional considerations for glucagon-like peptide-based therapies: An Asian Indian consensus recommendation

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonists, collectively called GLP-based therapies (GBTs), cause gastrointestinal adverse effects and alter dietary intake, leading to nutritional deficiencies and loss of muscle mass and bone density. Therefore, GBTs' use necessitates structured nutritional support, particularly among Asian Indians, given their diverse dietary patterns and high prevalence of sarcopenia. This consensus provides expert-driven, practical recommendations on key nutritional priorities to support the appropriate GBTs' use in individuals with type 2 diabetes mellitus and/or obesity.

This was a consensus-based study using a modified Delphi method with expert panel inputs informed by a literature review. The literature review was conducted before developing statements on challenges experienced by individuals on GBTs and strategies to mitigate micro- and macronutrient deficiencies to guide optimal GBTs' use. A total of 13 domain experts (endocrinologists and diabetologists) across India were included in this process.

Among 44 statements (11 sub-statements), 43 received high or moderate consensus, emphasizing the importance of early nutritional assessment and monitoring metabolic outcomes, with a tailored, balanced diet comprising complex carbohydrates, optimal high-quality protein, good-quality fat, micronutrients, and adequate hydration. The panel highlighted calorie-controlled meal replacement, including diabetes-specific nutritional (DSN) formulations, together with sustainable lifestyle practices and resistance exercise to support long-term metabolic health outcomes. After the discontinuation of GBTs, sustained nutritional support may help prevent metabolic rebound.

There is a need for structured nutritional support for individuals on GBTs, especially for Asian Indians, considering their dietary pattern and increased risk of sarcopenia. Implementing culturally driven nutritional recommendations, including DSN formula as an adjunct along with lifestyle modifications, can support optimizing long-term patient-centric outcomes. The effectiveness and safety of GBTs, along with newly emerging nutrient-stimulating hormone (NuSH) based therapies, should be evaluated in long-term follow-up studies.