According to Dr. Saptarshi Bhattacharya, senior consultant, endocrinology, Indraprastha Apollo Hospitals, the risk of diabetes rises significantly in one’s 40s and 50s due to a complex interplay of hormonal
changes, metabolic slowdown, and evolving lifestyle patterns. This period often acts as a turning point when the body’s internal regulatory systems particularly those linked to glucose metabolism and fat distribution begin to lose efficiency.
For women, Dr Bhattacharya explains that the transition into perimenopause and menopause leads to a sharp decline in estrogen levels. Estrogen plays a crucial role in maintaining insulin sensitivity and regulating fat storage. Once the hormone drops, most women tend to accumulate more visceral fat around the abdomen. This deep abdominal fat is metabolically active and releases inflammatory markers that interfere with insulin function. Lower estrogen levels also impact lipid metabolism, contributing to higher cholesterol and triglyceride levels, which further impair glucose regulation.
In men, Dr Bhattacharya notes that testosterone levels begin to dip more noticeably in the late 40s and 50s. Testosterone is essential for maintaining lean muscle mass and supporting the muscles’ ability to efficiently absorb glucose. As levels decline, muscle mass decreases and fat mass increases, slowing overall metabolism. Low testosterone is strongly associated with insulin resistance and metabolic syndrome, major precursors to type 2 diabetes.
Across both genders, other hormonal systems shift with age. Levels of growth hormone decrease, reducing muscle mass and increasing fat accumulation. Concurrently, chronic stress and poor sleep elevate cortisol levels. As Dr Bhattacharya highlights, persistently high cortisol increases glucose production in the liver and weakens insulin’s effectiveness, gradually raising blood sugar levels.
Body Composition Changes That Increase Diabetes Risk
Hormonal changes are accompanied by shifts in body composition. Sarcopenia, the age-related loss of muscle mass becomes more common in midlife. Since skeletal muscle is the primary site of glucose uptake, Dr. Bhattacharya emphasizes that reduced muscle mass significantly limits the body’s ability to regulate blood sugar. Meanwhile, visceral fat increases around abdominal organs and releases inflammatory chemicals and adipokines that disrupt insulin signalling. These changes can happen even if total body weight is stable, which means individuals may not recognize their declining metabolic health. This is why endocrinologists now assess waist circumference and muscle-to-fat ratio rather than relying solely on weight.
Lifestyle Factors in Midlife That Elevate Risk
Lifestyle shifts in the 40s and 50s often amplify biological risks. Work demands typically peak during this phase, leaving less time for exercise. Sedentary habits weaken muscle strength and slow metabolism, making insulin resistance more likely. Sleep issues also become more common, women may struggle with insomnia due to menopause, while men face higher rates of obstructive sleep apnea.
Poor sleep disrupts hunger hormones, increases cravings for high-carbohydrate foods, and raises cortisol, all of which impair glucose control. Stress levels also escalate during midlife due to professional pressure, financial responsibilities, and caregiving burdens. Persistent stress drives abdominal fat gain and worsens insulin resistance. Dietary habits may worsen as well, with more irregular meals, processed foods, late-night snacking, and emotional eating. Even small yearly weight gains during this time can dramatically increase diabetes risk, as the added fat tends to be visceral.
Co-existing Conditions That Add to the Risk
The prevalence of metabolic conditions such as hypertension, dyslipidaemia, fatty liver disease, and thyroid dysfunction also rises in the 40s and 50s. Dr. Bhattacharya stresses that these conditions share pathways with insulin resistance. For instance, hypothyroidism slows metabolism and promotes weight gain, while fatty liver reduces the liver’s ability to respond to insulin. Together, they create a cluster of cardiometabolic risks that accelerate the progression towards type 2 diabetes.
Why Screening and Prevention Are Crucial
Given these interconnected factors, Dr. Bhattacharya strongly recommends routine metabolic screening beginning in the early 40s. Important tests include fasting blood glucose, HbA1c, lipid profile, liver function tests, thyroid hormone levels, and waist circumference measurement.
Encouragingly, early intervention is highly effective. Regular exercise especially resistance training helps rebuild muscle mass and improve insulin sensitivity. Weight management, a balanced diet, proper sleep, and stress control also play critical roles. For individuals with high-risk factors, doctors may prescribe medications such as metformin or recommend vitamin D supplementation to prevent progression.
In essence, Dr Bhattacharya concludes that understanding how hormonal, metabolic, and lifestyle factors converge during midlife is essential for reducing diabetes risk and protecting long-term health.
