Diabetes is often called a silent disease because blood sugar can remain elevated for years without obvious symptoms.
A person may feel perfectly well while high glucose is gradually damaging the blood vessels, nerves, kidneys, eyes and heart.
India is already facing one of the world’s largest diabetes epidemics, has earned the notorious title of being ‘DIABETIC CAPITAL OF THE WORLD’.
The ICMR-INDIAB study estimates that about 101 million Indians have diabetes and another 136 million have prediabetes.
Approximately 57% of people with diabetes were estimated to remain undiagnosed. (Press Information Bureau)
Why the Indian phenotype is different?
One important reason Indians develop diabetes and cardiovascular disease at relatively younger ages is the “thin-fat” or Asian Indian phenotype. An Indian may have a seemingly normal BMI and still carry disproportionately high amounts of abdominal and visceral fat.
This means looking thin does not necessarily mean being metabolically healthy.
Compared with many Western populations, Asian Indians tend to develop insulin resistance, diabetes and cardiovascular risk at lower BMI and waist measurements.
Indian criteria therefore consider BMI ≥ 23 kg/m² as overweight and ≥25 kg/m² as obesity.
Waist circumference is particularly important: ≥90 cm in men and ≥80 cm in women indicates increased metabolic risk.
Body-fat percentage can provide another useful clue. There is no single universally accepted diabetes-specific body-fat cutoff for Indians, and easy measurement methods such as BIA (BioElectrical Impedance Analysis) can be commonly used.
However, excess body fat—particularly visceral fat—matters more than body weight alone.
A normal weighing scale can therefore provide false reassurance.
Risk factors you should not ignore
You should consider diabetes screening if you have:
* Family history of diabetes
* Abdominal obesity or increasing waist circumference
* BMI ≥23 kg/m²
* Sedentary lifestyle or prolonged sitting
* High intake of refined carbohydrates, sugary drinks or ultra-processed foods
* Hypertension
* High triglycerides or low HDL cholesterol
* Fatty liver
* PCOS or previous gestational diabetes
* History of cardiovascular disease
* Increasing age
* Smoking or excessive alcohol intake
* Previous prediabetes
* Sleep deprivation or obstructive sleep apnoea
Silent symptoms people often dismiss
Watch for increased thirst, frequent urination, unexplained fatigue, blurred vision, recurrent infections, slow wound healing, tingling or numbness in the feet, unexplained weight loss or increased hunger. But remember: absence of symptoms does not rule out diabetes.
When should Indians get tested?
Testing should not wait until symptoms appear. Adults should discuss diabetes screening from around age 35, and earlier testing is appropriate when risk factors are present. In urban India, sedentary lifestyles, central obesity and dietary changes make early screening particularly important. But rural India should not be overlooked—the diabetes epidemic is increasingly spreading beyond major cities, with substantial state-to-state variation. (PubMed)
A simple fasting glucose and HbA1c, with an oral glucose tolerance test when appropriate, can identify diabetes or prediabetes.
The most important message: Don’t judge your diabetes risk by your weight or appearance. In an Indian, “thin” does not always mean “metabolically healthy.” Check your waist, body composition, blood pressure, lipids and blood glucose—not just the weighing scale.