Diet, Lifestyle Behaviours and Bioactive Nutraceuticals in Glycemic Control Among Indian Type 2 Diabetes Patients

Abstract

Background: In India, type 2 diabetes mellitus (T2DM) affects an estimated of 101 million adults and a substantial number of treated T2DM patients are unable to achieve the recommended glycemic target. The current review is a narrative review which investigates the relationship between dietary patterns, lifestyle behaviours and natural bioactive compounds with glycemic control (represented primarily by glycated haemoglobin - HbA1c) among Indian adults with T2DM. Methods: PubMed, Scopus, ScienceDirect and Google Scholar were used to search literature, which included community- and hospital-based studies and clinical trials and national cohort studies conducted in India, primarily in the past two decades, focusing on plant-derived nutraceuticals. Results: High carbohydrate diets (mainly based on refined cereals and extra sugar) are repeatedly shown to be linked with increased HbA1c levels, and pulses, whole grains and increased dietary diversity are associated with better control. Each of these – low physical activity, long periods of sitting, inadequate sleep, psychological stress or tobacco and alcohol consumption – is associated with suboptimal glycemic outcomes on its own. Traditional Indian herbs and spices such as fenugreek (Trigonella foenum-graecum), bitter gourd (Momordica charantia), curcumin derived from turmeric, cinnamon and Gymnema sylvestre have been found to produce clinically significant decreases in HbA1c and fasting glucose in random trials and meta-analyses, and represent a natural-resource based approach to complement existing dietary and lifestyle guidance. Summary: The glycemic control of Indian T2DM patients is influenced both by their daily diet and lifestyle as well as the bioactive properties of the Indian food culture and traditional herbs. The combination of evidence-based nutraceuticals and culturally adapted lifestyle interventions appears to be a promising, yet under-explored approach to improving diabetes outcomes in India.