Diabetes risk rises early for South Asians in US despite healthy lifestyle, researchers warn

South Asian adults in the United States face a markedly higher risk of diabetes by midlife, despite reporting healthier diets, lower alcohol use and comparable exercise habits.

The study, published on February 11, 2026 in the Journal of the American Heart Association, found that South Asians have more diabetes and hypertension than most other population groups by midlife. By age 45, nearly one in three South Asian men had prediabetes, and nearly one in five South Asian women were affected — roughly twice the rate seen among white, Black, Hispanic and Chinese women.

By age 55, both South Asian men and women were at least twice as likely to develop diabetes as white adults.

The findings come from a large long-term study of 2,700 adults aged between 45 and 55 at enrolment. Researchers combined data from two long-running cohort studies: MASALA, which focuses on South Asian adults, and MESA, which includes white, Black, Hispanic and Chinese adults. The team examined how risk factors changed over a decade and how patterns differed by race, ethnicity and gender.

Participants with heritage from Bangladesh, India, Pakistan, Nepal and Sri Lanka had some of the highest prevalence of risk factors for heart disease when compared to other population groups. Yet South Asian men and women reported healthier diets, lower alcohol use, comparable physical activity and lower average body mass index than most other groups.

“The mismatch between healthier lifestyle behaviors and clinical risk was surprising,” said senior author Dr Namratha Kandula, professor of general internal medicine and epidemiology at the Northwestern University Feinberg School of Medicine, as quoted in a press release. “This paradox tells us we’re missing something fundamental to what is driving this elevated risk among South Asians.”

Kandula said the study has identified “a critical window in the 40s when risk is already high, but disease is still preventable”.

Prior data from MASALA show South Asians have more fat around their organs than other population groups, even at a normal or low BMI. This fat pattern, which may begin in childhood, is an important risk factor for heart disease and diabetes.

A growing global burden

The elevated diabetes risk among South Asians in the US reflects a wider global trend. India is now home to 90 million adults aged 20-79 years living with diabetes, making it the country with the second-largest diabetes population in the world after China, which has an estimated 148 million affected adults. The United States ranks third, with about 39 million adults living with the condition.

These figures come from the 11th edition of the IDF Diabetes Atlas, published by the International Diabetes Federation in the journal The Lancet Diabetes & Endocrinology in February 2026. The report warns that diabetes cases are rising rapidly across the globe.

Globally, diabetes affected 589 million adults or 11.11 per cent of the world’s adult population in 2024, meaning roughly one in nine adults worldwide was living with the condition. If current trends continue, the number is projected to climb to 853 million by 2050, pushing prevalence close to 13 per cent of the global adult population. China, India and the United States together account for about 277 million adults with diabetes in 2024.

Against this backdrop, the Northwestern study’s call for earlier and more proactive screening for South Asian adults takes on added urgency. Clinicians should begin looking for high blood sugar and other risk-enhancing factors before midlife, Kandula said, and provide culturally appropriate lifestyle counselling.

“Ask your doctor about early screening — and get your blood pressure, fasting glucose (or A1c), cholesterol and lipoprotein (A) checked before middle age because early detection, treatment and control of these risk factors can prevent heart disease,” the doctor stated.