India has earned the unfortunate title of the “diabetes capital of the world,” with an estimated 101 million adults living with the condition and another 136 million at risk due to prediabetes. Type 2 diabetes arises when the body fails to regulate blood sugar effectively. Several factors—such as genetics, obesity, sedentary lifestyles, poor diets, family history, high blood pressure, abnormal cholesterol, gestational diabetes, and stress—contribute to the disease’s growing prevalence. Because many cases are diagnosed late, complications affecting the eyes, kidneys, nerves, heart, and brain are common. Alarmingly, nearly one-third of patients also develop chronic kidney disease (CKD).
Beyond Standard Tests: Understanding the Hidden Complexity
Conventional clinical tests for diabetes—such as fasting blood glucose, HbA1c, and creatinine—offer only a limited picture. They fail to capture the complex biochemical disruptions underlying the disease and often cannot predict which patients are at greatest risk for complications. To bridge this gap, researchers from the Indian Institute of Technology Bombay (IIT Bombay), Osmania Medical College, and Clarity Bio Systems India Pvt. Ltd., Pune, turned to metabolomics—the study of small molecules in the blood. Their findings, published in the Journal of Proteome Research (July 2025), may help clinicians detect complications earlier and design more personalised treatments.
Mapping Diabetes Through Metabolomics
“Type 2 diabetes is not just about high blood sugar,” explains Ms. Sneha Rana, a Ph.D. scholar in Prof. Pramod Wangikar’s lab and the study’s first author. “It disrupts amino acids, fats, and other biochemical pathways. Standard tests often miss this hidden activity, which may begin years before symptoms appear.” To gain a comprehensive understanding, the researchers analysed hundreds of metabolites—tiny molecules that reflect cellular activity. By profiling them, scientists can detect early chemical shifts that precede visible disease symptoms.
India-Focused Insights: The Need for Local Research
Earlier metabolomics studies linked diabetes to molecules such as branched-chain amino acids (BCAAs), acylcarnitines, and certain lipids. However, most of this research focused on European or East Asian populations. Since genetics, diet, and lifestyle vary widely, findings from other regions may not apply to Indian patients. “Indians often develop diabetes at a younger age and lower body mass index than Western populations, and they face higher risks of kidney complications,” says Dr. Rakesh Sahay. “It was crucial to examine if Indian patients show different metabolic signatures.”
Study Design and Key Discoveries
As reported by iitb.ac.in, the research team collected whole blood samples from 52 volunteers at Osmania General Hospital, Hyderabad, between June 2021 and July 2022. The participants included 15 healthy controls, 23 people with type 2 diabetes, and 14 with diabetic kidney disease (DKD). Using liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS), the team screened nearly 300 metabolites. They identified 26 metabolites that differed between diabetic patients and healthy individuals. Predictably, markers such as glucose, cholesterol, and 1,5-anhydroglucitol stood out. Yet, newly associated molecules—like valerobetaine, ribothymidine, and fructosyl-pyroglutamate—revealed unexplored metabolic links. “This shows diabetes is a much broader metabolic disorder beyond glucose dysregulation,” notes Prof. Wangikar.
Two Distinct Metabolic Subgroups
The team also discovered two metabolic subgroups among diabetic patients. One group’s profile resembled healthy individuals, while the other displayed strong changes related to stress, inflammation, and energy metabolism. “These biomarkers could eventually be used like cholesterol tests to assess disease risk,” says Dr. Sahay. “Some patients may require intensive therapy, while others might respond better to lifestyle modifications.”
Predicting Kidney Complications Earlier
When comparing DKD patients with the other groups, researchers found seven metabolites that consistently increased with disease progression. These included sugar alcohols such as arabitol and myo-inositol, ribothymidine, and a toxin-like compound called 2PY, which builds up during kidney damage. “By tracking these molecules, we can predict kidney complications much earlier,” says Ms. Rana. “They could complement or even precede traditional markers like creatinine or eGFR, allowing early interventions to slow disease progression,” adds Dr. Manisha Sahay.
Whole Blood Analysis: A Step Toward Real-World Testing
Unlike most studies that examine only plasma or serum, this research analysed whole blood. “This has strong clinical potential because a test could be developed using dried blood spots from simple finger pricks,” explains Prof. Wangikar. Whole blood includes metabolites from red blood cells, offering a more complete picture of body chemistry. This may explain why some Western markers, like BCAAs, appeared less prominent in Indian samples—since their distribution varies by population and sample type.
The Road Ahead: Toward Personalised Diabetes Care
Although the study involved a small sample size, the team plans to expand it to include more patients with different diabetes complications. Their goal is to develop simple, affordable clinical tests that can detect early signs of risk and enable tailored treatment strategies. “In India, we often follow a one-size-fits-all approach to diabetes care,” says Ms. Rana. “These new biomarkers could help personalise treatment, ensuring every patient receives care that suits their unique profile.”