The disease progresses unchecked, hidden inside a diagnosis that feels right.
Within India's vast and growing diabetes crisis, a quieter condition hides in plain sight — Type 1.5 diabetes, an autoimmune disease that wears the mask of Type 2, affecting potentially millions who are being treated for the wrong illness. Unlike the lifestyle-driven form most associate with adult-onset diabetes, this condition arises from the immune system turning against itself, demanding insulin therapy that most patients never receive in time. It is a story of a disease that is not rare, only invisible — and of a healthcare system that has not yet learned to look for what it does not expect to find.
- An estimated 5 to 12 percent of India's 89.8 million diabetics may have Type 1.5, meaning millions are silently progressing toward complications under the wrong diagnosis.
- Because the disease mimics Type 2 diabetes in its early stages, patients are routinely sent home with diet advice and oral medications while autoimmune destruction of insulin-producing cells continues unchecked.
- Without insulin therapy, blood sugar control eventually collapses — leading to vision loss, nerve damage, and cardiovascular disease that could have been prevented with earlier intervention.
- Antibody testing can identify the condition in atypical Type 2 cases, but it is not standard practice, and awareness among both doctors and patients remains critically low.
- With India's diabetes burden projected to reach 156.7 million by 2050, closing this diagnostic gap is no longer a niche concern — it is a public health imperative.
India carries the world's second-largest diabetes burden, with nearly 90 million adults living with the disease today and projections pointing toward 157 million by 2050. But within those numbers lives a condition most patients and many doctors have never heard of: Type 1.5 diabetes, or LADA — Latent Autoimmune Diabetes in Adults — quietly and systematically mistaken for something else.
The confusion is almost structural. Type 1.5 doesn't arrive with the sudden crisis of childhood Type 1, nor does it fit the familiar lifestyle-driven profile of Type 2. It appears in adults over 30, progresses slowly, and on the surface looks exactly like Type 2 diabetes. What is actually happening, however, is an autoimmune attack — the immune system gradually destroying the cells that produce insulin. As Dr. Ramesh Goyal of Apollo Hospitals in Ahmedabad explains, lifestyle measures alone cannot reverse it, and most patients will eventually require insulin. But in the early months, blood sugar can still be managed without it — so patients receive a Type 2 diagnosis and go home with oral medications while the underlying destruction continues.
The symptoms offer no easy clues: unexplained weight loss, excessive thirst, blurred vision, tingling in the limbs. All of them can pass for poorly controlled Type 2. A 2025 review in the Cleveland Clinic Journal of Medicine flagged LADA as a condition that routinely leads to dangerous delays in insulin therapy, recommending antibody testing for atypical Type 2 presentations — but such testing is not routine, and atypical features are easy to overlook.
Experts estimate that between 5 and 12 percent of India's diabetic population may actually have Type 1.5 — potentially millions of people treated for the wrong condition. The true figure is likely higher still, because the disease is rarely tested for. Over time, patients on oral medications alone deteriorate. Complications accumulate. By the time insulin is finally introduced, significant damage has often already been done.
The path forward is not complicated: test for antibodies when the clinical picture doesn't quite fit. But it requires awareness, infrastructure, and a willingness to look past the obvious. For millions of Indians, that shift in attention could mean the difference between managing their disease and being slowly undone by it.
India carries the world's second-largest diabetes burden. Nearly 90 million adults are living with the disease today, and that number is expected to nearly double to 157 million by 2050. But hidden inside these statistics is a condition so quiet, so easy to overlook, that most patients and many doctors don't even know it exists. It's called Type 1.5 diabetes, or LADA—Latent Autoimmune Diabetes in Adults—and it's being systematically mistaken for something else.
The confusion is almost built into the disease itself. Type 1.5 doesn't announce itself the way Type 1 does in children, with sudden onset and obvious crisis. It doesn't fit the familiar profile of Type 2 either, the lifestyle-driven form that dominates public health messaging. Instead, it borrows from both worlds, appearing in adults over 30 with a slow, almost apologetic progression. On the surface, it looks exactly like Type 2. Which is why almost no one catches it.
What's actually happening inside the body is an autoimmune attack. The immune system turns on the cells that produce insulin, destroying them gradually over years. This is the crucial difference. "Since the disease is autoimmune in nature, lifestyle measures alone cannot reverse it," explains Dr. Ramesh Goyal, a senior endocrinologist at Apollo Hospitals in Ahmedabad. "It is a lifelong condition, and most patients eventually require insulin therapy." But here's the trap: in the first six months after onset, patients often don't need insulin yet. Their blood sugar can be managed without it. So when someone walks into a clinic with high blood sugar and no dramatic history, they get diagnosed with Type 2 and sent home with diet advice and oral medications. The autoimmune destruction continues silently underneath.
The symptoms don't help distinguish the condition early. They develop gradually—unexplained weight loss, excessive thirst, increased hunger, frequent urination, blurred vision, tingling in the limbs, delayed wound healing, a growing susceptibility to infections. None of these are unique to Type 1.5. All of them can look like poorly controlled Type 2 diabetes. A review published in the Cleveland Clinic Journal of Medicine in late 2025 described LADA as a slowly progressive autoimmune disease that often leads to misdiagnosis and dangerous delays in starting insulin therapy. The review emphasized the importance of antibody testing in patients who show atypical features of Type 2 diabetes—but antibody testing is not routine, and atypical features are easy to miss when you're already convinced you know what you're looking at.
The scale of the problem in India is staggering. Experts estimate that between 5 and 12 percent of all people living with diabetes in the country may actually have Type 1.5. Some data suggests the figure among those diagnosed as Type 2 could be as low as 4 percent or as high as 8 percent. Given that India has millions of diagnosed diabetics, this represents potentially millions of people being treated for the wrong condition. And the true burden is almost certainly higher, because widespread misclassification and lack of awareness throughout the healthcare system mean the condition simply isn't being looked for. Doctors don't test for it. Patients don't know to ask. The disease progresses unchecked.
The consequences accumulate over time. Patients treated with oral medications and lifestyle changes alone eventually fail those treatments. Their blood sugar control worsens. Complications develop—vision loss, nerve damage, poor wound healing, cardiovascular disease. All of this could be prevented or delayed with early insulin therapy. But by the time insulin is finally started, often years after the disease began, significant damage has already occurred. "Recognising the condition early can help ensure better blood sugar control and prevent long-term complications," Dr. Goyal says. In a country already carrying the world's second-largest diabetes burden, with projections showing that burden nearly doubling in the next 25 years, addressing this hidden epidemic might matter more than anyone realizes. The solution is straightforward: test for antibodies in patients with atypical presentations. But it requires awareness, infrastructure, and a willingness to look beyond the obvious diagnosis. For millions of Indians, that difference could mean the choice between managing their disease and being slowly destroyed by it.
Citas Notables
Since the disease is autoimmune in nature, lifestyle measures alone cannot reverse it. It is a lifelong condition, and most patients eventually require insulin therapy.— Dr. Ramesh Goyal, Senior Consultant Endocrinologist, Apollo Hospitals
Recognising the condition early can help ensure better blood sugar control and prevent long-term complications.— Dr. Ramesh Goyal
La Conversación del Hearth Otra perspectiva de la historia
Why does Type 1.5 diabetes get missed so consistently? It seems like it should be obvious.
Because it doesn't announce itself. Type 1 in children is dramatic—sudden onset, clear crisis. Type 2 is what everyone knows. Type 1.5 arrives quietly in middle age and borrows from both worlds. A doctor sees a 45-year-old with high blood sugar and no family history of Type 1, and the mind fills in Type 2 before the body has finished speaking.
But the symptoms must be different somehow.
They're not, really. That's the trap. Gradual weight loss, thirst, blurred vision—these fit Type 2 perfectly. The only way to know is to test for antibodies. But antibody testing isn't routine. It's not part of the standard diabetes workup. So the disease hides in plain sight.
What happens to someone who gets the wrong diagnosis?
They get told to diet and exercise, maybe prescribed oral medications. For a while, that might work. But the autoimmune destruction is happening underneath. Eventually the medications fail. By the time insulin is started—sometimes years later—complications have already set in. Vision loss, nerve damage, cardiovascular disease. All preventable if caught early.
How many people in India are we talking about?
Between 5 and 12 percent of the 90 million diabetics in the country. That could be millions of people. And the real number is probably higher, because most cases are never identified. The disease is being systematically overlooked.
What would it take to change this?
Awareness among doctors. A willingness to test for antibodies in patients who don't fit the Type 2 profile perfectly. Infrastructure to support that testing. It's not complicated. But it requires looking for something you've been trained not to see.