Predicting complications for diabetes in South Asians: Beyond convention

Type 2 diabetes disproportionately affects South Asian populations, who typically develop earlier onset disease associated with a high lifetime burden of complications. Conventional tools to predict diabetes complications, largely derived from European-ancestry cohorts and traditional clinical variables, perform suboptimally in South Asians and leave substantial residual risk unexplained. This review synthesises evidence on non-conventional predictors of microvascular and macrovascular complications in South Asian adults with type 2 diabetes. We examine life-course and early developmental determinants, ectopic fat, socioeconomic and environmental exposures, psychological and behavioural factors, non-conventional glycaemic metrics, novel organ-specific biomarkers, genetics, and artificial intelligence approaches. Although many predictors show promise, most lack validation in longitudinal South Asian cohorts and meaningful predictive value beyond existing clinical risk scores. Integrating diverse data types may enable more precise risk stratification, but robust external validation and evidence of improved patient outcomes are required before implementation in routine diabetes care.