India, currently recognized as the diabetes capital of the world, is firmly in the grip of a devastating metabolic epidemic. Historically, Type 2 diabetes was perceived as an affluent disease, predominantly affecting the upper socioeconomic strata. Today, however, this public health crisis has democratised in the worst way possible—plaguing the entire nation regardless of age, region, or economic background.

Since the 1990s, the country has witnessed a staggering 200% spike in the number of people living with the condition. Is this sudden surge primarily driven by dietary shifts? Is there an underlying genetic vulnerability unique to this ethnic group? Or are there broader environmental factors at play? Strikingly, India has now surpassed both China and the United States in diabetes prevalence, underscoring the urgent need for nuanced research to understand why this population is so uniquely vulnerable.

Diet and diabetes

For a long time, I believed the conventional narrative: that India’s food culture is anchored by a steadfast tradition of healthy, home-cooked, largely plant-based meals. However, recent public health data has exposed this idealised perception as a myth. A primary culprit hidden in plain sight is white rice—a foundational staple that, may be consumed two to three times a day in various culinary forms depending on region and community. Could this deep-rooted reliance on a refined carbohydrate be a primary driver of high blood sugar? Quite possibly. Furthermore, the Indian food landscape has undergone a rapid evolution over the last few decades, increasingly adopting dietary habits characterised by highly processed foods rich in simple carbohydrates and unhealthy fats.

The scale of this crisis is starkly illustrated by the landmark ICMR-INDIAB epidemiological study, which reveals that over 101 million Indian adults are currently living with diabetes, while an additional 136 million are trapped in the precarious stage of prediabetes. In total, approximately 237 million individuals exhibit abnormal blood glucose levels, with type 2 diabetes remaining the most pervasive diagnosis. Most alarming of all is the demographic shift: this metabolic disorder is no longer confined to the elderly, as younger adults are increasingly bearing the brunt of the epidemic.

What stress does

From a behavioural point of view, living under chronic stress frequently prompts individuals to resort to unhealthy coping strategies. A primary example is comfort eating, where an individual seeks comfort and a dopamine release from foods high in refined sugars (such as cakes, biscuits, and sweets), carbohydrates, and fats.

When stressed, nutritional awareness typically drops, leading to frequent snacking and fewer nourishing, balanced meals. This dietary shift significantly increases the risk of developing type 2 diabetes through several interconnected mechanisms.

When an individual facing chronic stress relies on high-sugar and high-carbohydrate foods for emotional regulation, it triggers rapid, frequent spikes in blood glucose. In response to these elevated blood sugar levels, the pancreas must secrete large amounts of insulin to metabolise and clear glucose from the bloodstream. Over time, this repeated cycle exposes the body to chronically high insulin levels. Consequently, the cells become desensitised to the hormone, developing insulin resistance—a pivotal factor in the onset of type 2 diabetes.

As insulin resistance takes hold, the pancreas is forced to work overtime. It attempts to secrete even more insulin to combat cellular resistance while simultaneously managing the ongoing high sugar intake, a state that often culminates in pancreatic fatigue. Furthermore, this surplus of fats and sugars, operating in tandem with the stress hormone cortisol, promotes visceral fat accumulation around internal organs. This fat distribution further accelerates metabolic dysfunction, creating a harmful, self-reinforcing cycle.

The metabolic-psychiatric link

The human body operates as a highly integrated biochemical network, governed by sophisticated, nuanced feedback loops and regulatory mechanisms. Because these systems function in close collaboration, neuroendocrine signaling plays a central role in bridging brain function with peripheral metabolism.

A prime example of this interplay is the hypothalamic-pituitary-adrenal (HPA) axis; its dysregulation has been deeply implicated in the pathophysiology of numerous mental illnesses. Consequently, there is a pronounced comorbidity between psychiatric disorders and metabolic diseases, specifically obesity and type 2 diabetes.

Emerging research demonstrates that individuals diagnosed with bipolar disorder, schizophrenia, and major depressive disorder consistently exhibit disruptions in glucose regulation, lipid metabolism, and autonomic function.

This relationship, though, is bidirectional. When metabolic function is skewed, it can amplify neuroinflammatory and oxidative stress pathways within the brain. This biochemical distress can, in turn, serve as a causal factor in exacerbating psychiatric symptoms and accelerating cognitive decline.

What this means

Historically, multidisciplinary team coordination in Indian patient care has been underutilised. This fragmentation is particularly detrimental given the bidirectional relationship between psychiatric and metabolic health; mental health conditions can precipitate diabetes, while poorly managed diabetes can exacerbate psychological distress.

To deliver optimal patient outcomes, a collaborative partnership between endocrinologists and mental health professionals is essential. Implementing integrated approaches—such as co-consultations or a single-panel framework—unites physical and mental healthcare rather than treating them in isolation.

Furthermore, this unified model helps dismantle deep-seated cultural taboos. By addressing the mind and body simultaneously, clinicians can gently challenge and reframe resistant mindsets, such as patients attributing severe distress or fatigue solely to “high sugar” rather than acknowledging an underlying mental health need.

(Rashikkha Ra. Iyer is a multidisciplinary clinician working in the U.K., specialising in the delivery of clinical interventions in forensic settings. Rashikkha.RaIyer@outlook.com)