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Type 2 diabetes is a complex and heterogeneous disease, influenced by both environmental and genetic factors. Early onset type 2 diabetes, defined as the onset of the disease before the age of 40, is of particular interest due to its strong genetic component. In this study, the genetics associations of early onset type 2 diabetes in the South Indian population are explored. Several risk factors for early onset type 2 diabetes are hereditary, including both polygenic and monogenic forms. Insulin resistance, glucose intolerance, and hyperglycemia are also common features in this population, which increase susceptibility and predisposition to developing the disease. Family history is a significant risk factor for early onset type 2 diabetes, highlighting the importance of genetic factors in disease pathogenesis. Genome-wide association studies (GWAS) and candidate gene approaches have identified several genetic markers and biomarkers associated with early onset type 2 diabetes. Single nucleotide polymorphisms (SNPs) have been linked to increased risk of developing the disease, while changes in gene expression and epigenetics, such as DNA methylation, have also been implicated in disease progression. Genetic counseling, personalized medicine, and precision medicine are potential avenues for disease prevention and management in individuals at high risk of developing early onset type 2 diabetes. Lifestyle changes, including exercise and diet, can also reduce the risk of developing the disease. Medications, such as insulin therapy and glucose-lowering agents, can improve beta-cell dysfunction and glycemic control in those with early onset type 2 diabetes. Comorbidities associated with the disease, such as obesity, metabolic syndrome, hypertension, dyslipidemia, and cardiovascular disease, must also be addressed to prevent complications such as neuropathy, retinopathy, and nephropathy.