Diabetes and obesity – collectively termed diabesity – constitute a rapidly escalating global health crisis, with particularly acute implications in South Asian populations. Unlike classical obesity patterns, South Asians often present a “thin-fat” phenotype – characterized by low body mass index but increased visceral adiposity, insulin resistance, and ectopic fat deposition – leading to earlier and more severe metabolic complications. This review synthesizes current evidence on the intertwined pathophysiology of diabesity, highlighting adipose dysfunction, chronic inflammation, and β-cell exhaustion as central drivers of insulin resistance and cardiometabolic risk. Recent advances in screening – including biomarkers, imaging technologies (dual-energy X-ray absorptiometry, magnetic resonance imaging), and digital monitoring (continuous glucose monitoring, wearables, and artificial intelligence [AI] analytics) – enable earlier detection and individualized risk stratification. Lifestyle modification remains foundational, supported by behavioral therapy and culturally adapted nutrition and exercise regimens. Pharmacologic innovations such as glucagon-like peptide-1 receptor agonists, dual incretin therapies (e.g., tirzepatide), and sodium-glucose cotransporter-2 inhibitors offer dual benefits in glycemic control and weight loss. For severe cases, bariatric surgery delivers high remission rates, while newer, minimally invasive approaches like electroceuticals, stem cell therapy, and hydrogels show promise in early trials. The integration of AI, telemedicine, and digital therapeutics has revolutionized real-time patient monitoring and engagement. Yet significant disparities persist in access and affordability of care, especially in low- and middle-income countries like India. Future directions must prioritize equitable access, precision medicine through genomics and metabolomics, AI-driven predictive tools, and policy innovations addressing food systems, digital divides, and healthcare funding. A systems-level strategy – combining public health policy, digital innovation, and precision medicine – is vital to combatting the diabesity epidemic in high-risk regions and ensuring scalable, sustainable, and personalized metabolic care.
Background: The rising prevalence of type 2 diabetes mellitus (T2DM) in India, driven by obesity and lifestyle factors, necessitates innovative treatments like oral Semaglutide, a GLP-1 receptor agonist (GLP-1RA). Its oral formulation enhances patient adherence by overcoming barriers associated with injectables, offering glycaemic control, weight loss, and cardiorenal benefits. Methods: A comprehensive literature review was conducted using PubMed, EMBASE, and Cochrane Library, focusing on oral Semaglutide and GLP-1 RAs. An expert panel convened on November 24, 2023, in Bengaluru, India, to develop guidelines for its use in T2DM management. Live opinion polls and panel discussions provided clinical insights across diverse patient populations. Results: Oral semaglutide demonstrated significant HbA1c reductions of −1.3% to −1.5% at 7 mg and 14 mg doses, and weight loss of up to 5 kg across diverse T2DM profiles, including drug-naïve individuals with normal BMI, obesity, ASCVD, and CKD. In CKD patients, it reduced nephropathy risk by HR 0.64 (95% CI: 0.46–0.88). Cardiovascular safety was supported by a 21% reduction in MACE in PIONEER 6. Additional benefits included improved blood pressure, lipid profiles, and a low risk of hypoglycemia, with consistent efficacy across special populations. Conclusion: Oral semaglutide offers a comprehensive, patient-centric approach to managing type 2 diabetes, with benefits extending beyond glycemic control to address cardiovascular, renal, and metabolic health. Its oral formulation enhances adherence, making it suitable for diverse patient populations. This expert consensus provides practical guidance for its effective use in routine clinical care.
Objective: The cardiovascular outcomes and value in the real world with GLP-1 receptor agonists study characterized demographics and medication usage patterns in treatment intensified (add-on to metformin) adults with type 2 diabetes (T2D) in India. Materials and Methods: This study was a retrospective, real-world analysis of data extracted from medical records at five healthcare centers across India during the study period (January 30, 2008–December 31, 2017). Data were collected at 6/12 months before baseline in the overall population and among subgroups defined by glucose-lowering agent (GLA) classes; summarized descriptively. Results: Data from 1000 adults were collected in reverse chronological order. At baseline, the mean age, glycated hemoglobin (HbA 1c ), T2D duration, and body mass index (BMI) of the study population were 51.4 years, 7.9%, 2.6 years, and 27.7 kg/m 2 , respectively. Overall, 81.4% of patients received one GLA and 71.4% had HbA 1c ≥7.0%. Among the subgroups, patients in sulphonylurea subgroup were older (52.5 years), those in glucagon-like peptide-1 receptor agonists (GLP-1RA) subgroup had higher BMI (35.9 kg/m 2 ), and, those in insulin subgroup had higher HbA 1c (9.5%); most frequently prescribed GLA postmetformin was dipeptidyl peptidase-4 inhibitors (42.7%). The utilization of GLP-1RAs/sodium-glucose cotransporter-2 inhibitors was low ( n = 10 and 145, respectively). Among the subgroups, receiving ≥3 GLAs was more common in the GLP-1RA subgroup. Conclusion: Glycemic control in Indian patients with T2D remains inadequate, with underutilization of GLAs with cardiovascular (CV) benefits. Further studies are needed to better estimate CV disease risk in this population and to grasp the reasons for underutilizing GLAs for relevant comorbidities. Trial registration: NCT05542420.
Rapid conversion from prediabetes to diabetes and frequent postprandial hyperglycemia (PPHG) is seen in Asian Indians. These should be the target of dietary strategies.We hypothesized that dietary intervention of preloading major meals with almonds in participants with prediabetes will decrease overall glycemia and PPHG.The study included two phases: (1) an oral glucose tolerance test (OGTT)-based crossover randomized control study, the effect of a single premeal almond load (20 g) given before OGTT was evaluated (n = 60, 30 each period). (2) The continuous glucose monitoring system (CGMS)-based study for 3 days including premeal almond load before three major meals was a free-living, open-labeled, crossover randomized control trial, where control and premeal almond load diets were compared for glycaemic control (n = 60, 30 in each period). The study was registered at clinicaltrials.gov (registration no. NCT04769726).In the OGTT-based study phase, the overall AUC for blood glucose, serum insulin, C-peptide, and plasma glucagon post-75 g oral glucose load was significantly lower for treatment vs. control diet (p < 0.001). Specifically, with the former diet, PPHG was significantly lower (18.05% in AUC on OGTT, 24.8% at 1-h, 28.9% at 2-h post OGTT, and 10.07% during CGMS). The CGMS data showed that premeal almond load significantly improved 24-glucose variability; SD of mean glucose concentration and mean of daily differences. Daily glycaemic control improved significantly as per the following: mean 24-h blood glucose concentration (M), time spent above 7.8 mmol/L of blood glucose, together with the corresponding AUC values. Premeal almond load significantly decreased following: overall hyperglycemia (glucose AUC), PPHG, peak 24-h glycaemia, and minimum glucose level during night.Incorporation of 20 g of almonds, 30 min before each major meal led to a significant decrease in PPHG (as revealed in OGTT-based study phase) and also improved insulin, C-peptide, glucagon levels, and improved glucose variability and glycemic parameters on CGMS in participants with prediabetes.The study was registered at clinicaltrials.gov (registration no. NCT04769726).
