Type 2 Diabetes Has Overtaken Type 1 in Young Patients. Are We Treating the Disease

Type 2 Diabetes Has Overtaken Type 1 in Young Patients. Are We Treating the Disease — or Its Consequence?

Before we talk about India's diabetes problem, perhaps we should first look at Tamil Nadu.

Today's (17/09/2026) Times of India reports a finding that should make all of us stop and think:

Type 2 diabetes has overtaken Type 1 diabetes among young patients.

The study analysed 10,449 people diagnosed with diabetes by the age of 25. Type 2 diabetes accounted for 51.6%, compared with 45.5% for Type 1.

What is particularly concerning is that Type 2 diabetes — traditionally considered a disease of adulthood — is increasingly appearing in young people.

Another important observation: obesity and family history were more prevalent among those with Type 2 diabetes.

Dr. V. Mohan of the Madras Diabetes Research Foundation has been highlighting the relationship between obesity and diabetes for years. His Diabetes Specialities Centre established an Obesity & Weight Management Centre in 2012 and a Bariatric Surgery Unit in 2013. Its current website continues to list procedures including gastric bypass and sleeve gastrectomy.

Dr. A. Ramachandran and his institution have also been prominent in diabetes care and research in Tamil Nadu, with a long-standing focus on diabetes prevention, metabolic health and complications.

So my question is not directed at one doctor or one hospital.

It is a question for the diabetes-care ecosystem.

We have known for years that obesity, physical inactivity, unhealthy dietary patterns and insulin resistance are closely associated with Type 2 diabetes.

We also know that when obesity becomes severe, lifestyle advice alone may not be sufficient for every patient, and that metabolic/bariatric surgery can produce substantial weight loss and significant improvement in Type 2 diabetes in appropriately selected patients.

Then why isn't the conversation about obesity and metabolic intervention much louder when we discuss the diabetes epidemic among young Indians?

Are we intervening early enough?

A young person becomes overweight.

Then obese.

Then severely obese.

Then insulin resistant.

Then prediabetic.

Then diabetic.

And eventually, hypertension, fatty liver, sleep apnoea, kidney disease, neuropathy, retinopathy and cardiovascular risk may enter the picture.

At every stage, there is an opportunity to intervene.

But very often, our conversation becomes:

“Your sugar is high. Let's control the sugar.”

Shouldn't we also ask:

“Why is the sugar high in the first place?”

This is where I believe the roles of the diabetologist and bariatric/metabolic surgeon should complement each other.

Not Diabetologist vs Surgeon.

Not Medicine vs Surgery.

But:

Diabetes management + obesity management + metabolic intervention, when clinically appropriate.

And this is especially important for young patients.

If a 25-year-old is already diabetic because severe obesity and insulin resistance are major contributors, should our objective simply be to keep that person on diabetes medication for the next 30, 40 or 50 years?

Or should we also ask whether there is an opportunity to fundamentally change the metabolic condition driving the disease?

This does not mean every diabetic patient needs bariatric surgery.

It does not mean surgery is a shortcut.

And it certainly does not make lifestyle modification unimportant.

It means that appropriately selected patients deserve to know that metabolic surgery is one of the evidence-based treatment options available to them.

If leading diabetes institutions in Tamil Nadu have been discussing obesity, metabolic health and even bariatric surgery for years, perhaps the larger healthcare system needs to ask why this approach has not become more deeply integrated into routine diabetes care.

Because today's young diabetic is not just a blood-sugar number.

He or she is a young person potentially facing decades of metabolic disease.

Perhaps we need to stop asking only:

“How do we control diabetes?”

And start asking:

“How do we change the metabolic trajectory that produced it?”

That conversation needs to begin before the complications begin.

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