For years, type 2 diabetes was considered a disease of middle and older age. Today, doctors across India are diagnosing it in people in their twenties and thirties, a condition once seen mainly after the age of 45. It has become a major public health and economic challenge. India has one of the world's youngest populations, with a median age of just over 29 years. Yet it is home to one of the world's largest numbers of people living with diabetes. Nearly one in four Indian adults has prediabetes, and one in seven has diabetes, many remaining undiagnosed until complications affecting the heart, kidneys, eyes or nerves have already developed.

Why are Indians developing diabetes so early?

The answer lies in the interaction between inherited biological vulnerability and rapid lifestyle change. Many Indians develop type 2 diabetes despite appearing slim because they carry more abdominal and liver fat and less muscle, a pattern known as the "thin-fat" Indian phenotype. This promotes insulin resistance, allowing diabetes to develop at lower body weights. Consequently, Western BMI cut-offs often underestimate diabetes risk in Indians.

Risk starts early and lifestyle makes it worse

The foundations of diabetes may be laid before adulthood. Poor maternal nutrition, low birth weight followed by rapid childhood weight gain, and inadequate early-life nutrition can permanently alter glucose metabolism. Genetics loads the gun; the environment pulls the trigger.

Rapid urbanisation has transformed how Indians eat, work and live. Declining physical activity, rising consumption of ultra-processed foods, prolonged sitting, poor sleep, chronic stress and low muscle mass together promote insulin resistance, leading to early-onset type 2 diabetes.

The workplace: part of the problem, part of the solution

Today's workplaces often involve prolonged sitting, chronic stress, late meetings, irregular eating and, for many, shift work, all of which increase the risk of type 2 diabetes. At the same time, workplaces offer important opportunities for prevention through screening and wellness programmes.

Recent corporate screening data reinforce this message. A nationwide analysis found that diabetes prevalence among employees increased from 7.89% to 8.85%, while prediabetes rose from 19.38% to 24.40% between 2023-24 and 2024-25. The burden was highest among people aged 31-50 years, although even employees in their twenties showed a notable rise.

Why early diabetes is more dangerous

Developing diabetes at 35 instead of 50 means living with the disease for many more years. A 2025 Lancet review showed that early-onset type 2 diabetes progresses more aggressively, with faster loss of pancreatic beta-cell function. Combined with a longer duration of diabetes, this substantially increases the lifetime risk of heart disease, stroke, kidney disease, vision loss and nerve damage.

The good news: Prediabetes is reversible

Prediabetes is not a life sentence, it is an opportunity. Identifying high-risk individuals early and sustaining lifestyle changes can delay or prevent type 2 diabetes. Regular physical activity, strength training, healthy eating, adequate sleep, weight management and timely medical care remain the cornerstones of prevention, together with early screening for those with a family history or abdominal obesity.

The road ahead

India's diabetes epidemic cannot be explained by sugar alone. It reflects the convergence of a uniquely vulnerable biology with rapid urbanisation and changing lifestyles. If India is to realise its demographic dividend, policy must act now to prevent diabetes before it develops-in homes, schools, workplaces and communities that make healthy living the easier choice.

Preventing diabetes at 35 is not simply about avoiding a disease; it is about protecting the health, productivity and future of an entire generation. The time to start prevention is long before diabetes begins.

References

1. Madhu SV, Raizada N. Diabetes in the workplace: risks and remedies. Indian J Endocrinol Metab. 2025;29(6):587-589. doi:10.4103/ijem.ijem_1019_25.

2. MediBuddy study Corporate India health screening data. https://www.pharmabiz.com/NewsDetails.aspx?aid=180927&sid=2

3. Luk A, Wild SH, Jones S, Anjana RM, Hivert MF, McCaffrey J, et al. Early-onset type 2 diabetes: the next major diabetes transition. Lancet. 2025;405(10497):2313-2326. doi:10.1016/S0140-6736(25)00830-X.

(Dr. Rajiva Gupta, Senior Consultant, Internal Medicine and Diabetes, practicing in Gurgaon at CK Birla Hospital and Upchar Wellness)



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