Published Nov 14, 2026 | 7:00 AM ⚊ Updated Nov 14, 2026 | 7:00 AM
Blood sugar levels can change in response to meals, physical activity, medicines, illness and stress.
Synopsis: Type 2 diabetes is increasingly being diagnosed among younger adults across South India. NFHS-6 data show rising levels of elevated blood sugar, while doctors warn that many remain undiagnosed for years. They explain how early-onset diabetes, insulin resistance and delayed treatment can lead to kidney, heart and eye complications.
Diabetes can remain unnoticed for years. Some people experience no obvious symptoms even as persistently high blood sugar begins damaging their kidneys, eyes, nerves and heart. By the time they are diagnosed, the condition may have already affected vital organs.
Doctors across South India are increasingly concerned about this delayed diagnosis, particularly as they see more people developing Type 2 diabetes in their 20s and 30s.
The latest National Family Health Survey (NFHS-6) findings show an increase in the proportion of adults with high or very high blood sugar levels, or those taking medication to control it, across southern states.
Nationally, the proportion increased from 15.6 percent to 20.9 percent among men between NFHS-5 and NFHS-6, and from 13.5 percent to 17.8 percent among women.
Kerala recorded the highest proportions among southern states, with 31.9 percent of men and 28.9 percent of women meeting this indicator. Karnataka recorded a sharp increase, from 15.6 percent to 26.1 percent among men and from 14 percent to 22.3 percent among women. Tamil Nadu, Andhra Pradesh and Telangana also reported increases among both men and women.
The indicator includes people with blood sugar levels above 140 mg/dl and those taking medication to control their blood sugar. It does not represent clinically confirmed diabetes prevalence.
“There is definitely a genuine increase in the disease. It is not just a result of better detection; the overall prevalence is also increasing,” Dr Pramila Kalra, Senior Consultant, Department of Endocrinology, Ramaiah Memorial Hospital, Bengaluru, told South First.
Dr Lijo George, Consultant in Internal Medicine at Apollo Adlux Hospital, Angamaly, Kerala, said the findings reflected both an increase in metabolic disorders and improved detection.
“The rise cannot be attributed to better detection alone. Urbanisation, sedentary lifestyles, unhealthy dietary patterns, increasing abdominal obesity, stress and inadequate physical activity are contributing to the growing diabetes burden,” he said.
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Doctors say Type 2 diabetes is increasingly being diagnosed among people in their 20s and 30s.
“The prevalence of diabetes among people in the 20–30 age group, or even those between 18 and 30 years, is increasing alarmingly,” Dr Kalra said.
She attributed the trend to a lack of physical activity, greater access to junk food, higher consumption of refined carbohydrates, lower intake of fibre and protein, increased screen time, stress and inadequate sleep. She also expressed concern about rising obesity among teenagers, saying they could be at higher risk of developing diabetes over the next four to five years.
Dr George said early onset meant people could live with the condition for several decades.
“This is particularly concerning because an earlier onset means individuals may live with diabetes for several decades, increasing their lifetime risk of complications,” he said.
Dr Preema Khan, Consultant in Internal Medicine at KIMS Hospitals, Electronic City, Bengaluru, said younger people often did not consider themselves at risk.
“Some young adults could be quite healthy in appearance, but have increased abdominal fat, decreased muscle mass, and some metabolic disturbances,” she told South First. “The problem is also in the fact that many younger people do not visit doctors and have regular health check-ups, as they think that diabetes is associated with ageing only. As a result, diabetes is diagnosed only when symptoms occur or when the person visits a doctor for other health issues.”
Dr Khan said sedentary lifestyles, excessive sitting, poor nutrition, overconsumption of refined carbohydrates, lack of sleep and stress were contributing to the trend. Genetic susceptibility, combined with environmental and lifestyle factors, also increases the risk of insulin resistance among Indians.
The distribution of body fat is another concern. Dr Khan described the South Asian or thin-fat phenotype, in which a person may have relatively lower muscle mass but more body fat, particularly around the stomach and internal organs.
“Visceral fat, in particular, poses a great risk because it tends to produce inflammatory and fatty acids which impair the functioning of insulin,” she said.
Dr George said South Asians could develop metabolic abnormalities at comparatively lower body mass index (BMI) levels than many Western populations. “The important factor is not simply body weight but where fat is distributed,” he said. “Some individuals may appear relatively lean but have excess abdominal fat, reduced muscle mass and underlying metabolic abnormalities.”
He said BMI alone was insufficient to assess diabetes risk. Waist circumference, physical activity, family history, blood pressure and lipid levels also needed to be considered.
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One of the challenges with Type 2 diabetes is that it can develop gradually without obvious symptoms.
Dr Khan said early symptoms could be mild and mistaken for stress, ageing or changes in lifestyle. Some people were diagnosed only after developing complications such as kidney dysfunction, neuropathy or heart disease.
“The problem here is that organs might get damaged even before a person is officially diagnosed with diabetes,” she said.
Dr George said a significant proportion of people with Type 2 diabetes remained undiagnosed for years because they experienced no noticeable symptoms during the early stages.
“Diabetes may first be detected during investigations for another condition, such as heart disease, kidney dysfunction or eye problems,” he said.
Common symptoms include excessive thirst, frequent urination, fatigue, increased hunger, unexplained weight loss and blurred vision. Recurrent skin or urinary infections and wounds that heal slowly can also be warning signs.
Dr Kalra said almost 50 percent of people with diabetes may not know they have the condition and could remain undiagnosed for years. She urged people experiencing frequent urination, unexplained weight loss, recurrent infections or wounds that do not heal to get tested.
Explaining how uncontrolled diabetes affects the body, Dr George said persistently elevated blood glucose damages blood vessels and nerves.
“The kidneys are very susceptible to complications of uncontrolled blood sugar because their fine filtration systems become damaged, leading to diabetic kidney diseases and sometimes even kidney failure,” he said.
Diabetes also increases the risk of heart attacks and strokes. Damage to small blood vessels in the eyes can cause diabetic retinopathy, while nerve damage can result in tingling, numbness and burning sensations, particularly in the feet.
“One of the most concerning aspects is that considerable organ damage can develop before patients experience noticeable symptoms. For example, diabetic kidney disease may remain asymptomatic during its early stages,” Dr George said.
He recommended regular urine albumin-to-creatinine ratio tests, kidney function assessments, retinal examinations and foot examinations for people with diabetes.
Diabetes may also not always be recorded as the underlying cause of death. A person may die from a heart attack, stroke or kidney failure, while diabetes is documented as an associated condition.
Dr George pointed to Kerala’s 2024 Medical Certification of Cause of Death report, which recorded diabetes mellitus as accounting for 16.36 percent of all medically certified deaths in the state.
“The cause of death will be given in terms of heart attack, stroke or kidney failure while diabetes plays an important role as the underlying cause. Therefore, the number of deaths attributed to diabetes may not give the true picture of its role in mortality,” he said.
Doctors said diabetes management required regular monitoring, medication adherence and lifestyle changes. Skipping medicines, stopping treatment when symptoms improve and missing follow-up consultations can leave blood sugar uncontrolled.
Dr Khan said some patients discontinue medication once they start feeling better, even though diabetes remains a chronic condition.
“Diabetes is a chronic disease, which means its symptoms will improve despite the fact that the disease is still existing,” she said.
Dr Kalra recommended HbA1c testing every three months to monitor average blood glucose levels. For most patients, the target is generally below 7 percent, although it needs to be individualised. Patients should also undergo regular checks for kidney, eye and nerve complications.
Dr George said treatment needed to be reviewed periodically and tailored to the patient’s age, duration of diabetes and associated medical conditions.
Newer medicines, including GLP-1 receptor agonists and SGLT2 inhibitors, have expanded treatment beyond blood sugar control. Dr George said some medicines in these groups also offered cardiovascular and kidney benefits, although their use depended on clinical assessment, side effects and affordability.
All three doctors called for earlier screening, particularly among people with a family history of diabetes, abdominal obesity, hypertension and sedentary lifestyles.
Dr Khan said screening should not be limited to people who already have symptoms. Dr George also called for a shift towards prevention and long-term management.
“Screening should not be restricted to older adults. Individuals with a family history, abdominal obesity, hypertension, sedentary lifestyles or a history of gestational diabetes should undergo earlier assessment,” he said.
He added that the focus of diabetes care should extend beyond diagnosis and prescriptions. “The real measure of success should be how effectively we prevent complications, preserve organ function and improve the long-term quality of life of people living with diabetes.”
(Edited by Dese Gowda)
