Published Mar 31, 2026 | 10:00 AM ⚊ Updated Mar 31, 2026 | 10:00 AM
India has more than 101 million people living with diabetes. (iStock)
Synopsis: A decade-long study has found that men and women with type 2 diabetes face markedly different risks of serious complications, challenging the idea that diabetes can be managed the same way for everyone.
Meena* had managed her diabetes for seven years without a major problem. She monitored her blood sugar, took medication, and kept clinic appointments. What she did not monitor were her legs.
A burning sensation in her feet brought her to a vascular clinic, followed by numbness she had ignored for months. A Doppler scan showed that the arteries supplying blood to her lower limbs were significantly narrowed. She had peripheral artery disease, a condition that increases the risk of ulcers, gangrene, and amputation.
She was not unusual. She was, according to a new study from Chennai, the kind of patient the system is most likely to miss.
“Women have a higher risk of peripheral arterial disease and lower risk of diabetic retinopathy and coronary artery disease,” the authors noted.
Published in the Indian Journal of Medical Research, the study tracked 1,053 people with type 2 diabetes over roughly nine years as part of the Chennai Urban Rural Epidemiological Study (CURES), one of India’s largest community-based cohorts.
It is among the first from a developing country to report not just how many people have complications, but how many develop them over time.
Type 2 diabetes is often reduced to high blood sugar. But over time, elevated glucose damages blood vessels and nerves throughout the body. The eyes, kidneys, heart, legs, and feet are all vulnerable. The damage is gradual and often silent until symptoms appear.
The study described diabetes as a leading contributor to illness and death due to its effects on both microvascular systems such as the eyes, kidneys, and nerves, and macrovascular systems including coronary and peripheral arteries.
The Chennai data puts scale to that damage. Among participants who began without complications, nearly two in three developed nerve damage over the follow-up period. Around one in three developed heart disease, kidney disease, or eye damage. Peripheral artery disease affected nearly one in three overall.
These are not rare outcomes. For many patients, they are the expected trajectory unless risk factors are tightly controlled.
“Understanding the occurrence of diabetes related complications and the factors that contribute to their development is essential for designing and implementing more effective preventive strategies,” the authors wrote.
Peripheral artery disease (PAD) occurs when arteries supplying the limbs become narrowed, reducing blood flow to the legs and feet. In early stages, it causes pain while walking. In advanced stages, it can lead to non-healing wounds and amputation.
In the general population, PAD is more commonly associated with men. In this study, that pattern reversed.
More than 35 percent of women developed PAD over nine years, compared to just under 24 percent of men. After adjusting for factors such as age, blood sugar, blood pressure, cholesterol, body mass index, and smoking, women had a 62 percent higher risk of developing PAD.
“Women showed a higher risk of peripheral artery disease, with an adjusted risk ratio of 1.62,” the authors noted.
The reasons are likely biological. Hormonal and metabolic differences influence how blood vessels respond to prolonged high blood sugar. Fat distribution and vascular function differ between sexes, which may contribute to this pattern. Some studies also suggest that vascular symptoms in women may be under-recognised in clinical settings.
Women also showed higher raw rates of kidney disease, though this difference was not statistically significant after adjustments.
Men in the study were more likely to develop diabetic retinopathy, a condition caused by damage to blood vessels in the retina and a leading cause of blindness. Thirty-seven percent of men developed retinopathy compared to 27 percent of women.
“Men had higher rates of diabetic retinopathy (37.0 vs. 27.3%) and coronary artery disease (36.2 vs. 34.5%),” the study reported.
Men were also more likely to develop coronary artery disease. While the absolute difference was small, adjusted analysis showed women had a 40 per cent lower risk compared to men.
This reflects a known pattern. Women are generally protected against heart disease by oestrogen, but diabetes reduces that protection.
“Diabetes weakens this advantage, narrowing the coronary artery disease risk gap between sexes,” the authors of the study noted.
Peripheral neuropathy, or nerve damage, showed no meaningful difference between sexes. It affected about 63 percent of men and 62.7 percent of women.
“There were no sex differences for developing kidney disease and peripheral neuropathy,” the study concluded.
This is significant. Neuropathy is a major driver of foot ulcers and amputations. The fact that it affects both sexes equally underscores how widespread and the severity of the complication.
The study also noted that this incidence is higher than reported in several international studies, indicating a heavier burden in India.
The complication rates reported in Chennai are higher than those seen in many other countries. For example, earlier international studies have reported lower rates of retinopathy over similar time periods.
“The observed incidence rate of diabetic retinopathy… was notably higher than rates previously reported in the UK Prospective Diabetes Study,” the authors noted.
Several factors may explain this finding. Diabetes tends to occur earlier in Indian populations, increasing lifetime exposure to high blood sugar. Control of blood sugar, blood pressure, and cholesterol also remains suboptimal for many patients.
In the Chennai cohort, a large proportion of participants had poor glycaemic control and rising rates of hypertension at follow-up.
These conditions accelerate damage to blood vessels and organs.
India has more than 101 million people living with diabetes. If the patterns seen in Chennai are even partly representative, the future burden of complications will be substantial.
The study argued for a shift in managing diabetes.
“These sex-specific patterns underscore the need for clinicians to incorporate individualised risk profiling into routine diabetes care,” the authors wrote.
For women, this means earlier screening for peripheral artery disease, which is often overlooked. Simple tests such as the ankle-brachial index can detect reduced blood flow early.
For men, greater focus is needed on eye screening and cardiovascular risk assessment. Regular retinal imaging and heart evaluations should be part of routine care.
For both sexes, controlling blood sugar, blood pressure, and cholesterol remains critical.
The study has important strengths, including long follow-up and standardised assessments. However, only about 55 percent of the original participants were available for follow-up, which may introduce bias.
“The reported figures should be interpreted as incidence among the followed-up participants,” the authors cautioned.
The study was also conducted in an urban population, which may limit generalisation.
Diabetes is often discussed through large numbers. But behind each statistic is a person who develops complications over time, often silently.
“The incidence of diabetes complications in this urban Asian-Indian population is high compared to western populations,” the study concluded.
The Chennai findings suggested that complications are not random. They follow patterns shaped in part by sex. Recognising those patterns could help detect problems earlier and prevent severe outcomes.
The challenge now is whether the healthcare system can act on that knowledge.
(*Name changed. Edited by Majnu Babu).
