India, often dubbed the diabetes capital of the world, currently has an estimated 101 million adults living with diabetes and another 136 million with prediabetes — making Type 2 diabetes a major public health challenge. The disease, driven by genetics, obesity, sedentary lifestyles, and poor diet, often goes undiagnosed until serious complications arise, affecting the eyes, kidneys, nerves, heart, and brain. Nearly one-third of diabetic patients also develop chronic kidney disease (CKD).
Standard diagnostic tests such as fasting glucose, HbA1c, and creatinine capture only a limited part of the disease’s complexity. To gain deeper insights, researchers from IIT Bombay and Osmania Medical College, in collaboration with Clarity Bio Systems India Pvt. Ltd., Pune, have used metabolomics—the study of small molecules in the blood—to uncover biochemical signatures that may predict kidney complications early.
Their study, published in the Journal of Proteome Research (July 2025), was led by Prof. Pramod Wangikar (IIT Bombay) along with Dr. Rakesh Kumar Sahay and Dr. Manisha Sahay (Osmania Medical College). “Type 2 diabetes is not just about high blood sugar; it disrupts multiple metabolic pathways that standard tests often miss,” explained Sneha Rana, Ph.D. scholar and first author of the paper.
The team analysed whole blood samples from 52 participants—healthy individuals, diabetic patients, and those with diabetic kidney disease (DKD)—collected at Osmania General Hospital between June 2021 and July 2022. Using advanced liquid and gas chromatography-mass spectrometry (LC-MS and GC-MS), they scanned nearly 300 metabolites and identified 26 that differed significantly between diabetic and healthy individuals.
Unexpected markers such as valerobetaine, ribothymidine, and fructosyl-pyroglutamate emerged, suggesting that diabetes affects far more than glucose metabolism. The study also revealed two metabolic subgroups among diabetic patients—one resembling healthy profiles and the other showing strong signs of inflammation and stress. These differences, the researchers suggest, could help tailor treatments more precisely in the future.
Crucially, the team identified seven metabolites that increased progressively from healthy to diabetic to DKD patients. These included myo-inositol, arabitol, ribothymidine, and a toxin-like compound 2PY, which accumulates when kidney function declines. Monitoring these molecules could help detect kidney damage before traditional tests like creatinine or eGFR reveal abnormalities.
Unlike most previous studies, this research used whole-blood samples instead of plasma, capturing metabolites from red blood cells as well. “This approach can be easily adapted into a simple test using dried blood spots from a finger prick,” said Prof. Wangikar, adding that the team is working toward clinical translation.
While the current study involved a relatively small sample size, the researchers plan to expand it for larger-scale validation. “With these new metabolic markers, we can move toward personalised diabetes care instead of a one-size-fits-all model,” said Ms. Rana, emphasising the potential for early diagnosis and prevention of complications.