05 — Regional focus

South Asia: the epicentre of the metabolic crisis.

India and Pakistan carry a disproportionate share of the global diabetes burden — at lower body-mass indices, earlier ages, and with far fewer trained clinicians per capita than the OECD average. The established preventative playbook does not transfer cleanly. DIFFERENCE's research programme has to meet these populations where they are.

The numbers

Figures below are drawn from the ICMR-INDIAB longitudinal study (published 2023, covering 113 000 participants across every Indian state and union territory) and the International Diabetes Federation Diabetes Atlas (10th edition, 2021, with country-level 2022 updates). They are estimates — the underlying detection rate is itself one of the things a serious research programme in the region must improve.

India

~101 million adults living with diabetes

A further ~136 million with prediabetes (ICMR-INDIAB 2023).
~315 million with abdominal obesity — the strongest early metabolic flag in this phenotype.
Urban prevalence (up to 16%) is now outpacing many Western populations.

Pakistan

~33 million adults living with diabetes

Age-adjusted prevalence of ~30% — the highest national rate recorded in IDF's 2022 update.
Roughly 1 in 4 adults undiagnosed, by the same IDF estimates.
Rapid urbanisation + nutrition transition are accelerating incidence faster than health-service capacity can follow.

South-Asian phenotype

Diabetes develops at lower BMI

Clinically meaningful insulin resistance appears in South Asians at BMIs around 23, where Caucasian thresholds are 25.
Higher visceral-to-subcutaneous fat ratio at the same waist measurement — the "thin-fat" phenotype.
Western screening cut-offs under-diagnose the population by design.

Training capacity

Severe specialist gap

India has roughly one endocrinologist per 80 000 people with diabetes, concentrated in tier-1 cities.
Pakistan has fewer than 500 qualified diabetologists for a population of 240 million.
Primary-care training on insulin-assay interpretation and the Kraft methodology is effectively absent in undergraduate medical curricula.

What DIFFERENCE would introduce

The Foundation's 2026 programme already names low-cost lipid meters, advanced insulin measurement, and open-source dashboards as priorities. The South Asia focus brings these to where they have the greatest marginal impact — and adds two additional programme elements shaped for the region.

1. Regional training fellowships

A two-year fellowship bringing primary-care physicians, nutritionists and diabetology registrars from Indian and Pakistani centres into rigorous quantitative protocols — Kraft insulin-curve interpretation, continuous glucose data analysis, lipoprotein particle sizing, and study design.

Graduates return to their institutions as instructors. Cohort size: 40–60 fellows per year in year 1, ramping to 200+ once regional training centres are accredited.

2. KRAFT screening at primary-care scale

Partner with state-level health services and district hospitals to deploy the Kraft insulin assay as a routine screen — targeting the 10–15-year window before OGTT-defined diabetes during which hyperinsulinaemia is the only signal. Pair with the low-cost lipid meter already on the 2026 programme.

Pilot geographies: Kerala, Tamil Nadu and Karnataka (strong primary-care backbone) in India; Punjab and Sindh in Pakistan (highest prevalence regions).

3. South-Asian phenotype research grants

Dedicated funding for investigator-led research on the thin-fat phenotype, postprandial glucose excursions on traditional versus transitioning diets, and low-cost biomarkers that hold predictive value in this population specifically. Selection by the Scientific Investment Council under the same rigor standards as every DIFFERENCE grant.

4. Localised dashboards & decision support

The open-source visualisation dashboard on the 2026 programme ships with reference ranges, thresholds and phenotype labels tuned for South Asian populations — not retrofitted from Caucasian norms. Available in English, Hindi, Urdu, Tamil, and Bengali. Deployed via the AWS Lambda + Grafana stack already funded.

5. Insurance-industry partnerships

Pakistan and India's life and health insurance markets are an order of magnitude less developed than Europe's, yet face some of the largest actuarial upside from reducing diabetes incidence. Partnerships with Indian and Pakistani insurers — mirroring DIFFERENCE's European model — to co-fund screening and risk-stratify portfolios on rigorously-derived metabolic indices.

6. Public-health policy briefings

Quarterly briefings to the Indian Ministry of Health & Family Welfare, the Pakistani Ministry of National Health Services, and the WHO Regional Office for South-East Asia (SEARO) — translating DIFFERENCE-funded research into policy-ready recommendations.

Why the timing matters

India and Pakistan are mid-way through the nutrition transition — the decade or so during which traditional dietary patterns give way to refined carbohydrates, industrial seed oils, and packaged foods. Every other country that has completed this transition has paid for it with a diabetes explosion that national health budgets then spend a generation absorbing.

South Asia does not have to follow that curve. The quantitative evidence base needed to change the trajectory is buildable now, and the cost of building it is a rounding error compared to the cost of treating the disease burden it would prevent. That is the case the Foundation is here to fund.

Sources: ICMR-INDIAB (2023) · IDF Diabetes Atlas, 10th edition (2021) and country updates (2022) · WHO Global Status Report on NCDs. Figures are estimates and should be cited as such.