Research Highlight

Diabetes alarm for India’s metros

doi:10.1038/nindia.2020.177 Published online 23 November 2020

Over half the men and two thirds of women above the age of 20 in India's metropolitan cities are likely to develop diabetes during their lifetime, says a study by an international team of scientists from India, the UK and the USA1.

Prevention of diabetes, especially in young urban populations, should be a national priority for India, they say. "Such high probability of developing diabetes will have severe implications for India's already strained health system," says lead author Shammi Luhar at the University of Cambridge, UK.

This estimation of lifetime risk of diabetes in urban India banks on data from the Centre for Cardiometabolic Risk Reduction  in South Asia (CARRS) Cohort Study – a community-based health survey project in Delhi and Chennai in India and Karachi in Pakistan – besides from the Indian Council for Medical Research and  Indian government reports on age, sex, and urban-specific mortality rates.

The researchers found that "metropolitan Indians at every age have an alarmingly high probability of developing diabetes compared with results from high income countries." Women generally had a higher lifetime risk and the risk was highest among obese metropolitan Indians: 86% among 20-year-old women and 87% among men. However, normal or underweight individuals were projected to live out most of their remaining years diabetes-free.  

"Our results are much closer to estimates of lifetime risk of diabetes among black and Hispanic populations in the USA", the authors say.  Low diabetes-free life expectancy in urban India, especially for individuals with high Body Mass Index (BMI), mean that diabetes prevention programmes involving a combination of lifestyle interventions with a course of medication may be of paramount importance, the researchers note.

Co-author Viswanathan Mohan of the Madras Diabetes Research Foundation in Chennai says despite high predicted lifetime risks it is possible to prevent or postpone diabetes by effective lifestyle modification, such as following a healthy diet, by increasing physical activity and reducing body weight in those who are overweight.

Says Muthuswamy Balasubramanyam, a disease-biologist and associate dean of medical research at the SRM Institute of Science and Technology in Chennai, "The considerably higher lifetime risk of developing diabetes among Indians at lower ages implies a role of ‘accelerated ageing’. This needs expanded research, prevention strategies and health policy interventions.”


1. Luhar, S.  et al. Lifetime risk of diabetes in metropolitan cities in India. Diabetologia (2020) doi: 10.1007/s00125-020-05330-1