XVIII Международная студенческая научная конференция Студенческий научный форум - 2026

The prevalence, awareness, treatment and control of diabetes in India has the following characteristics:

1. The “Thin–Fat Indian” Phenotype. Many Indians develop type 2 diabetes at a lower BMI than Western populations.Why? They have higher abdominal (visceral) fat and lower muscle mass. So, someone who looks “not overweight” can still be insulin-resistant. This is why BMI cut-offs for diabetes risk are lower for Indians.

2. Earlier Age of Onset. Diabetes in India often appears 10–15 years earlier than in Western countries. Commonly diagnosed in the 30s or 40s. Leads to longer lifetime exposure to complications (heart, kidney, eyes). This makes diabetes an economic and productivity issue, not just a health one.

3. Carb-Heavy Traditional Diet (Not Just Sugar!). In India, diabetes risk is driven more by refined carbohydrates than sweets alone:

• white rice

• wheat flour (maida)

• idli, dosa, poori, roti (large portions, low fiber)

Even “home food” can spike blood sugar if portion size and fiber balance are off.

4. High Rates of Undiagnosed Diabetes. A large number of Indians live with diabetes without knowing it because:

• symptoms appear late

• routine screening is uncommon

• healthcare access varies widely

• many people are diagnosed only after complications begin.

5. Urbanization of Diabetes (Now Spreading Rural). Originally called a “rich city disease,” diabetes is now:

• rapidly rising in rural India

• linked to mechanization, packaged foods, and reduced physical labor

• villages are seeing diabetes without seeing awareness.

6. Gestational Diabetes Is Exceptionally Common. Indian women have one of the highest risks of gestational diabetes globally. Often occurs even in normal-weight women. Strongly predicts future diabetes in both mother and child. This creates a cycle of diabetes across generations.

7. Cultural Barriers to Management.

• unique challenges in India:

• festival foods (sweets during Diwali, weddings, fasting–feasting cycles)

• social pressure to eat

• walking barefoot → higher risk of diabetic foot infections

• use of alternative medicine without glucose monitoring

8. Spices: Helpful but Not a Cure. Spices like turmeric, fenugreek, cinnamon may improve insulin sensitivity slightly—but:

• they cannot replace medication

• over-reliance delays proper treatment

• this misconception is particularly common in India.

9. Diabetes + Tuberculosis Connection. India faces a rare dual burden:

• Diabetes triples the risk of TB

• TB worsens blood sugar control

This interaction is far less common in high-income countries.

10. Economic Impact Is Massive. Most diabetes care is out-of-pocket. Costs push families into financial stress. Lost workdays + long-term complications = national productivity loss

11. India Is Also a Global Diabetes Innovator.

Despite challenges, India leads in:

• low-cost insulin and generic medicines

• telemedicine & app-based diabetes care

• large-scale screening programs

• yoga-based lifestyle interventions studied globally

Genetic diabetes

1. Strong Genetic Predisposition at Lower Body Weight. Indians inherit a high-risk genetic architecture for diabetes that: promotes insulin resistance, reduces beta-cell (insulin-producing cell) reserve.

So, diabetes appears earlier and at lower BMI, even without obesity. This genetic vulnerability becomes dangerous when paired with modern diets.

2. Higher Familial Clustering. In India:

• Diabetes often affects multiple generations

• If both parents are diabetic, the child’s risk can exceed 60–70%

• Joint family structures make this clustering more visible than in Western nuclear families.

3. Monogenic Diabetes (MODY) Is Underdiagnosed. India has a large but hidden burden of MODY (Maturity-Onset Diabetes of the Young): often misdiagnosed as type 1 or type 2, many patients unnecessarily receive insulin, genetic testing is limited due to cost and awareness, so MODY remains “invisible.”

4. Unique Indian MODY Patterns. Compared to Western countries: MODY-3 (HNF1A) and MODY-12 are more frequently reported, Mutations differ even within the same MODY subtype. This suggests population-specific genetic variants.

5. “Thrifty Genotype” Effect. Indian populations are thought to carry thrifty genes: efficient energy storage during famine, harmful in modern calorie-rich environments, this evolutionary advantage now contributes to diabetes epidemics.

6. Strong Maternal Transmission. Children born to diabetic Indian mothers show:

higher insulin resistance, earlier diabetes onset. This is due to both genes and intrauterine programming, a phenomenon strongly observed in India.

7. Neonatal Diabetes Has Distinct Indian Features. India reports: rare genetic forms of diabetes presenting before 6 months of age, many cases respond dramatically to oral sulfonylureas instead of insulin, delayed genetic diagnosis means many infants remain on insulin unnecessarily.

8. Endogamy Amplifies Genetic Risk. India’s social structure (caste, clan, regional endogamy): limits genetic mixing, increases expression of recessive diabetes-related mutations. This is far less common in Western populations.

9. Regional Genetic Differences. Diabetes-linked genetic variants differ across India:

South Indians: higher insulin resistance, North Indians: higher central obesity, Tribal populations: rapid diabetes emergence after urban exposure. India cannot be treated as one genetic unit.

10. Interaction of Genetics with Vegetarian Diets. Long-term vegetarian diets: lower protein intake, higher carbohydrate load. In genetically susceptible Indians, this worsens beta-cell stress and accelerates diabetes.

11. Genetic Risk Without Autoimmunity. Many young Indians with diabetes: are not obese, do not have autoimmune markers. This creates a hybrid genetic diabetes pattern distinct from classic type 1 or type 2 diabetes.

12. Limited Genetic Counselling Infrastructure. Despite high genetic risk: very few genetic counselling centres, minimal family-based screening, most diagnoses remain reactive, not preventive.

13. India’s Role in Global Genetic Research. India contributes to: discovery of novel diabetes-related gene variants, large population-based genome studies, insights into gene-environment interaction. Indian genetic data is reshaping global diabetes understanding.

Aged diabetes.

1. “Survivor Diabetes” in Indian Elderly. Many older Indians with diabetes have lived with the disease for decades, often diagnosed late and treated inconsistently. Result:

Complications (heart, kidney, nerve, eye) are more advanced, multiple organ involvement is common at first hospital visit.

2. Diabetes Appears “Milder” but Is Actually Riskier. In elderly Indians: blood sugar may not be extremely high; symptoms are subtle or absent. But they face higher risk of falls, infections, dehydration, and strokes, making diabetes more dangerous despite modest glucose levels.

3. High Hypoglycemia Risk Due to Food Insecurity. Unique Indian issue: fixed or no income, irregular meals, religious fasting. This makes low blood sugar (hypoglycemia) more common and more dangerous in the aged than high sugar.

4. Strong Link with Undernutrition. Unlike Western countries: many elderly diabetics in India are underweight or sarcopenic; muscle loss worsens insulin resistance; protein deficiency accelerates frailty. This creates a paradox: thin body, poor sugar control.

5. Polypharmacy + Self-Medication. Older Indians often: take medicines from multiple doctors; use Ayurvedic/home remedies alongside allopathic drugs; share medicines with spouses or neighbors. This increases drug interactions and unsafe sugar fluctuations.

6. Diabetic Foot Is More Severe. India has higher rates of: barefoot walking at home or temples, poor footwear, late presentation of foot wounds. Among the aged, this leads to higher amputation rates than in many countries.

7. Vision Loss Is a Major Disability. Elderly Indians with diabetes commonly suffer from: diabetic retinopathy, cataracts (earlier onset), glaucoma. Vision loss severely impacts independence because elderly Indians often depend on walking and public transport.

8. Diabetes and Cognitive Decline. Diabetes in aged Indians is strongly associated with:

early memory loss, vascular dementia. This is worsened by poor blood pressure control and limited mental health screening.

9. Gender Disparity in Care. Older women with diabetes in India: are diagnosed later, receive less aggressive treatment, prioritize family needs over their own health. This leads to worse outcomes despite longer life expectancy.

10. Social Isolation Worsens Outcomes. Many elderly diabetics: live alone while children work in cities or abroad, miss medications, skip follow-ups. Diabetes management heavily depends on family support, which is increasingly absent.

11. Financial Dependency Shapes Treatment Choices. Doctors often choose: cheaper medicines over ideal ones, less frequent monitoring. This makes elderly diabetes care in India cost-driven rather than guideline-driven.

12. Cultural Belief: “Sugar Is Normal in Old Age”. A dangerous myth in India:

“At this age, sugar is expected.” This delays diagnosis and treatment until complications become irreversible.

13. Unique Care Priorities for Aged Indians. Unlike younger adults, goals are: avoid hypoglycaemia, preserve mobility, maintain vision, prevent falls, simplify medication regimens. Strict sugar targets are often unsafe for Indian elderly.

*The review article has been written under the guidance of Associate Professor of biology department of Orenburg State Medical University, Cand. Sc. (Biology), G.F. Kolchugina

*Данная обзорная статья написана под руководством доцента кафедры биологии Оренбургского государственного медицинского университета, кандидата биологических наук Г.Ф. Кольчугиной.

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