Today India is facing an alarming surge in young-onset diabetes. Recent studies indicate that the country bears the highest burden of childhood and youth-onset diabetes cases globally, with one in four individuals diagnosed with the disease being under the age of 35.
This demographic shift demands urgent attention from healthcare providers and policymakers alike.
Understanding the disease
Young-onset diabetes is characterised by insulin resistance and a faster decline in insulin-producing beta cells, often presenting with more severe symptoms and an aggressive progression compared to adult-onset diabetes.
The disease’s impact on younger individuals is compounded by an increased risk of early complications, the need for intensive disease management, and adverse psychological effects that can disrupt the most productive years of life.
Risk factors
The Indian population has unique vulnerabilities, particularly the characteristic ‘thin-fat’ phenotype of south Asians. This term describes individuals with normal body weight but higher fat accumulation around the abdomen and internal organs, making them more susceptible to metabolic disorders, even at lower BMIs than their Western counterparts.
When diabetes develops at a young age, complications tend to manifest earlier and progress rapidly.
Within the first decade of diagnosis, over 50% of affected youth develop at least one serious complication, including kidney disease (nephropathy), eye damage (retinopathy), or nerve damage (neuropathy).
These conditions significantly affect the quality of life and increase the long-term healthcare burden.
Lifestyle triggers
Modern lifestyle changes have fuelled the epidemic, with childhood and adolescent obesity emerging as a key driver.
Increased screen time, reduced physical activity, and dietary shifts toward processed foods and refined carbohydrates have exacerbated the crisis.
The Covid pandemic further intensified these risk factors, leading to increased sedentary behaviour, disrupted sleep patterns, and unhealthy eating habits among young people.
The Kerala context
Kerala faces a particularly concerning situation, with diabetes prevalence reaching 25% — the third highest in India after Goa and Puducherry.
Unlike many other states, Kerala shows no significant urban-rural divide in diabetes rates. The state’s evolving food culture has played a major role in this crisis, with an increasing reliance on restaurant food and takeaway meals.
Combined with a sedentary lifestyle, this shift has made Kerala one of India’s diabetes hotspots.
Early detection
Early identification is crucial in curbing young-onset diabetes. Children who are overweight or obese should be screened from age 10 or at the onset of puberty, especially in case of additional factors such as a family history of diabetes, high blood pressure, abnormal cholesterol levels, or signs of insulin resistance (e.g., dark patches of skin on the neck, armpits, or groin).
If initial screening results are normal, testing should be repeated every 2–3 years or more frequently if risk factors increase.
Prevention strategies
Preventing young-onset diabetes requires a holistic approach.
Mindful eating:
Dietary management should focus on mindful eating — being fully present during meals, paying attention to portion sizes, and making conscious food choices. A balanced plate should consist of:
50% non-starchy vegetables
25% lean protein sources (such as fish, poultry, or legumes)
25% high-fibre carbohydrates (such as whole grains and fruits)
Prioritise unprocessed foods while limiting sugar, refined carbohydrates, and trans fats. Eating slowly and stopping when satisfied rather than full can prevent overeating and help regulate blood sugar levels
Physical activity:
Exercise plays a crucial role in diabetes prevention and management.
Children and adolescents should engage in at least 60 minutes of moderate to vigorous physical activity daily, including muscle-strengthening exercises thrice a week
Young adults should aim for 150–300 minutes of moderate-intensity aerobic activity per week, supplemented by regular resistance training
Brisk walking, cycling, swimming, and sports can be effective, depending on individual preferences
Lifestyle modifications:
Beyond diet and exercise, other lifestyle habits significantly impact diabetes risk:
Adequate sleep is essential, as poor sleep disrupts metabolism and increases insulin resistance
Stress management techniques like yoga help regulate cortisol levels and improve blood sugar control
Reducing screen time and prolonged sitting can prevent sedentary lifestyle-related metabolic dysfunction
Gradual changes in daily habits are more effective than abrupt overhauls.
Looking forward
Policymakers, healthcare professionals, and the community must work together to curb young-onset diabetes and protect the future health of our youth.
The writer is a consultant endocrinologist at SP Medifort Hospital in Thiruvananthapuram
