The Hidden Metabolic Truth

Multiple cohort and mechanistic studies consistently confirm that insulin resistance precedes hyperglycaemia by several years and represents the central driver of type 2 diabetes in Indians.

Obesity Prevention

Insulin Resistance — The Central Driver

Insulin resistance precedes hyperglycaemia by several years
Visceral adiposity
Physical inactivity
High-glycaemic, ultra-processed diets
Sleep deprivation and chronic stress

Metabolic Consequences of Insulin Resistance

Increased hepatic glucose output
Impaired skeletal muscle glucose uptake
Lipotoxicity
β-cell stress and eventual β-cell failure

Obesity and Fat Distribution

Visceral fat is more diabetogenic than subcutaneous fat
Waist circumference predicts risk better than BMI
Thin–fat Indian phenotype is common

Genetics and Family History

Strong familial aggregation of type 2 diabetes
Lower functional β-cell reserve
Genetic susceptibility interacts with lifestyle factors

Glycaemic Risk Spectrum

IFG / IGT: 5–10× higher diabetes risk
Prediabetes: 30–70% lifetime risk
History of gestational diabetes: very high risk
Risk rises continuously with no safe threshold

Dyslipidaemia and Diabetes

Elevated triglycerides
Low HDL-C
Small dense LDL particles

Hypertension and Diabetes

Shared pathophysiological pathways
Elevated blood pressure predicts future diabetes
Independent of BMI

Evidence-Aligned Prevention Strategy

Early identification of insulin resistance
Routine waist circumference measurement
Screening in individuals with family history
Structured lifestyle intervention programs

Risk of Heart Disease Risk of Diabetes Risk of Obesity Heart Disease Prevention Diabetes Prevention Obesity Prevention