133

As part of its Health Series, Indiaspora hosted the second episode, a virtual discussion titled “Sweet Truths: Diabetes in the South Asian Community,” on January 21, 2026. The session focused on diabetes and related health challenges disproportionately affecting South Asians worldwide.

Highlighting diabetes as a global health crisis with a particularly severe impact on South Asians, Indiaspora Founder MR Rangaswami emphasized in his welcome remarks, “We are four times more likely than Europeans to get diabetes. This is not a great stat we want to excel in.”

Rangaswami noted that approximately 90 million South Asians currently live with diabetes, a figure projected to rise to 150 million by 2045.

The discussion brought together leading experts who examined these trends, shared actionable insights, and explored strategies to strengthen diabetes prevention and management across South Asian populations.

Former U.S. Surgeon General Dr. Vivek Murthy delivered the opening remarks. A panel discussion followed, moderated by Dr. Nalini Saligram, session chair and Founder and CEO of Arogya World. Panelists included Dr. K.M. Venkat Narayan, Executive Director of the Emory Global Diabetes Research Center; Dr. Ravichandran Ramaswamy, Professor in the Department of Medicine, Biochemistry and Molecular Pharmacology at NYU Grossman School of Medicine; and Dr. Alka Kanaya, Professor of Medicine, Epidemiology, and Biostatistics at the University of California, San Francisco, and Principal Investigator of the MASALA Study.

In his remarks, Dr. Murthy referenced Rangaswami’s observation about elevated diabetes risk among South Asians, stating, “We excel in a lot of areas, academics, economic accomplishments, all kinds of achievements, but one place where I worry about our community is with regard to health.”

Commending Indiaspora’s leadership in organizing discussions on diabetes and heart health, Dr. Murthy said these efforts “are all part of an effort to help us understand what we can do to help mitigate some of the increased risk that our community is at for conditions like diabetes.”

He noted the growing prevalence of diabetes diagnoses, adding, “I’ve certainly seen that in my extended family in India. I’ve seen that in family members here in the United States as well. And this is not a coincidence.”

According to Dr. Murthy, diabetes prevalence is likely underreported, particularly in South Asia, due to significant detection challenges. Many individuals remain undiagnosed, suggesting actual numbers may be substantially higher.

“One thing it’s important for us to know is that our bodies, for genetic reasons, behave differently than perhaps other people in the population, which is why our we are at increased risk of diabetes compared to white populations around anywhere from a two to four-fold increase in risk,” he said.

Dr. Murthy also noted that South Asians often develop diabetes five to 10 years earlier than other populations. He cautioned that body mass index levels considered normal in the general population, such as 23 or 24, may still place South Asians at increased risk.

He explained that South Asians tend to accumulate visceral fat in the abdominal region, contributing to higher insulin resistance. Fat deposition in muscles can also result in individuals appearing slim while still having elevated insulin resistance and diabetes risk.

While underscoring the role of proper diet and exercise in reducing risk, Dr. Murthy recommended regular monitoring of Hemoglobin A1C, a measure of long-term glucose control, as well as assessments of visceral fat to better understand rising risk levels.

During the panel discussion, Dr. Saligram asked why Indians and South Asians experience diabetes at such high rates and how their risk compares to other Americans.

Dr. Venkat Narayan, who has studied diabetes since 1992, explained that increased risk among South Asians stems from two primary factors: biological and lifestyle or environmental influences. At a deeper biological level, he cited three key contributors: lower insulin secretion compared to other populations, reduced muscle mass which affects energy expenditure, and rapid accumulation of fat in the liver. Together, these factors significantly elevate diabetes risk.

Addressing why diabetes leads to heart disease and other complications, Dr. Ramaswamy explained that under normal conditions, the heart derives energy from burning glucose or fat. In diabetes, however, glucose is diverted into pathways that do not produce energy, depriving the heart of necessary fuel. This energy deficit alters heart muscle proteins, weakens contraction, and disrupts blood flow due to impaired blood vessel signaling. As a result, diabetes contributes to reduced energy production, weakened heart function, and compromised blood supply to the heart.

Discussing diabetes prevention and the relative roles of diet and exercise, Dr. Kanaya cited multiple global studies demonstrating a 50 to 60 percent reduction in diabetes incidence among individuals who adopted lifestyle changes. These randomized trials showed that participants who modified their diet and increased physical activity, such as walking, significantly lowered their risk compared to those who made no changes.

However, Dr. Kanaya noted that even with lifestyle modifications, South Asians often do not secrete sufficient insulin, leading to ongoing complications. “The biggest problem in the South Asian diabetes pathophysiology is the secretion of insulin is not easy to reverse with diet and lifestyle changes,” she said.

She described Hemoglobin A1C as one of the easiest tests for patients since it does not require fasting, while noting that studies, including those from MASALA, show Indians tend to have slightly higher A1C levels than other populations. She attributed this to nutritional deficiencies or differences in hemoglobin protein structure.

“So not everybody runs high, but there’s the higher proportion of Indians that seem to run high on the Hemoglobin A1C. As a primary care doctor myself, I push the fasting glucose test as something that I would advise all of my patients to do every single year, regardless of their BMI…” she emphasized.

Panelists also discussed the “thin-fat Indian” phenomenon, the importance of measuring visceral fat, updated U.S. dietary guidelines, emerging diabetes research, the impact of GLP-1 agonists and artificial intelligence in diabetes care, and ongoing clinical studies examining alternative therapies, including herbal supplements and Ayurveda, for diabetes management.