Research Society for the Study of Diabetes in India (RSSDI) multidisciplinary expert consensus recommendations on role of oral fluid, electrolytes, and energy management in persons with diabetes

Abstract Fluid, electrolyte, and energy (FEE) management plays a crucial role in the recovery of patients with type 2 diabetes mellitus (T2DM) and prediabetes, especially during acute non-diarrheal illnesses. However, current diabetes management guidelines often lack specific recommendations on how to address the unique FEE needs of these patients, leading to potential gaps in managing dehydration and energy deficits. In this article, we aimed to develop practical consensus recommendations on the role of FEE management in persons with diabetes (PWDs). Modified Delphi consensus methodology was utilized to reach a consensus. A scientific committee comprising 11 experts from India formed the panel. Relevant clinical questions within four major domains were formulated for presentation and discussion: (i) burden of FEE deficits in PWDs; (ii) assessment of FEE deficits in PWDs; (iii) role of FEE management in the recovery of T2DM; and (iv) importance of sustained energy concepts in meeting the energy requirements of T2DM. The consensus level was classified as “Yes” (when ≥ 70% of participants agree/strongly agree or disagree/strongly disagree with a statement) and “No” (when < 70% of participants agree/strongly agree or disagree/strongly disagree with a statement). The questions that lacked agreement were discussed during the virtual meeting. The experts agreed that slow-release carbohydrates, such as isomaltulose, D-tagatose, and trehalose, offer an effective solution for meeting energy requirements while stabilizing blood glucose levels and reducing glycemic variability. Ready-to-drink formulations that combine electrolytes, fluids, and slow-release carbohydrates provide a balanced approach to hydration and energy needs, which is particularly beneficial for patients with T2DM who are experiencing dehydration. Incorporating tailored FEE recommendations into existing guidelines could significantly enhance patient care by ensuring optimal hydration, electrolyte balance, and glucose control. This approach would be especially beneficial for patients with comorbidities or those at a higher risk of dehydration, supporting improved recovery and metabolic stability.