When Diabetes Hurts More Than the Body: Emotional Toll on South Asians

44% and Rising: The Alarming Prevalence of Diabetes Distress in South Asia

Type 2 diabetes (T2D) is often viewed as a physical condition—but for many South Asians, it’s also an emotional one. Diabetes distress (DD), the psychological burden of managing diabetes, is alarmingly prevalent in South Asian populations, both in their native countries and abroad. Yet, it remains under-recognized in clinical settings.

The Numbers Tell a Story

A recent systematic review and meta-analysis published in the World Journal of Diabetes revealed that 44% of South Asians with T2D experience diabetes distress—significantly higher than the 36% global prevalence reported by Perrin et al [Diabet Med. 2017 Nov;34(11):1508-1520]. 

This disparity underscores a unique vulnerability in South Asian communities [World J Diabetes. 2025 Aug 15;16(8):109352].

Even more concerning is the 60% prevalence of emotional burden, the most common form of DD in the region. Emotional burden refers to the feelings of frustration, fear, guilt, and helplessness that often accompany diabetes management. These emotions can severely impact health-related quality of life and self-care behaviors.

Why Is Distress So High in South Asians?

Several factors contribute to this elevated distress:

• Misconceptions about diabetes

Cultural beliefs often frame diabetes as a moral or personal failure, leading to shame and secrecy.

• Socioeconomic challenges

Limited access to healthcare, low health literacy, and financial constraints make diabetes harder to manage.

• Cultural stigma around mental health

Emotional suffering is frequently minimized or ignored, leaving DD unaddressed.

• Gender dynamics

Women often bear the brunt of emotional burden 

The Immigrant Experience

In New York City, the DREAM Initiative study found that 15.9% of South Asian immigrants with uncontrolled T2D reported high overall DD. While lower than rates in South Asia, emotional burden (25.9%) and regimen-related distress (21.9%) were still significant. Mental health challenges and low emotional support were strongly associated with higher distress levels [BMC Public Health. 2025 Feb 2;25(1):422]. These factors are discussed in detail in my blog article. The Emotional Weight of Diabetes in South Asian Lives

Key findings from the DREAM Initiative study

Emotional Burden (DDS Subscale)

• Individuals born in Bangladesh had 90% lower odds of emotional burden compared to those from Guyana or Trinidad and Tobago (OR = 0.1, p < 0.001).

• Experiencing ≥1 day of poor mental health in the past month was associated with 4.5 times higher odds of emotional burden (OR = 4.5, p < 0.001).

• Individuals with less than a high school education had 4.4 times higher odds of emotional burden compared to college graduates (OR = 4.4, p = 0.009).

Physician-Related Distress

• Individuals with ≥1 day of poor mental health had 4.6 times higher odds of physician-related distress compared to those with no poor mental health days (OR = 4.6, p = 0.007).

Regimen-Related Distress

• Individuals born in Bangladesh had 80% lower odds of regimen-related distress compared to those from Guyana or Trinidad and Tobago (OR = 0.2, p = 0.006).

• Lower emotional support was significantly associated with higher regimen-related distress (OR = 0.95, p = 0.012).

• Higher HbA1c levels were linked to increased regimen-related distress (OR = 1.45, p < 0.001).

Final Thought

Diabetes distress is a silent epidemic in South Asian communities. With nearly half of patients affected, and emotional burden peaking at 60%, clinicians must act. Recognizing and treating DD is not just compassionate—it’s essential for effective diabetes care.

References

• Kamrul-Hasan ABM, Pappachan JM, Nagendra L, Muthukuda D, Dutta D, Bhattacharya S, Shrestha D, Dhakal GP, Sumanatilleke M, Raza SA, Kalra S. Prevalence of diabetes distress among people with type 2 diabetes in South Asia: A systematic review and meta-analysis. World J Diabetes. 2025 Aug 15;16(8):109352. doi: 10.4239/wjd.v16.i8.109352.

• Mohsin F, Wyatt L, Belli H, Ali S, Onakomaiya D, Misra S, Yusuf Y, Mammen S, Zanowiak J, Hussain S, Zafar H, Lim S, Islam N, Ahmed N. Diabetes distress among immigrants of south Asian descent living in New York City: baseline results from the DREAM randomized control trial. BMC Public Health. 2025 Feb 2;25(1):422. doi: 10.1186/s12889-025-21535-8.

• Perrin NE, Davies MJ, Robertson N, Snoek FJ, Khunti K. The prevalence of diabetes-specific emotional distress in people with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med. 2017 Nov;34(11):1508-1520. doi: 10.1111/dme.13448.