India is grappling with a rapidly escalating diabetes crisis, as new data reveals the country has the highest number of people living with the disease globally. According to a study published in The Lancet on November 13, 2023, India’s diabetic population has surged to 212 million, up from around 200 million in 1990. This stark rise in cases is part of a broader global trend, with the worldwide number of people with diabetes skyrocketing from 200 million in 1990 to over 800 million by 2022. Additionally, global diabetes prevalence in adults has doubled from 7% to 14% in the same period.
While China ranks second with 148 million cases, India leads the world in the number of untreated diabetes cases. A staggering 133 million adults in India over the age of 30 are living with untreated diabetes, compared to 78 million in China. These figures underscore the urgent need for better diagnosis and treatment strategies in India, where many individuals remain unaware of their condition until serious complications arise.
Why the Sharp Rise?
One of the key reasons for the dramatic increase in diabetes cases is the more inclusive and comprehensive methodology used in the latest study. Unlike previous research that relied on a single biomarker, such as elevated fasting plasma glucose levels, this study — conducted by the NCD Risk Factor Collaboration in support of the World Health Organization (WHO) — also took into account people with elevated glycated hemoglobin (HbA1c) levels. HbA1c is a marker for long-term blood sugar control, and by including it, the study captured a larger portion of the population with undiagnosed or poorly controlled diabetes, especially in South Asia.
The prevalence of diabetes in India has undoubtedly increased over the last three decades, but the exact numbers may be higher than previously estimated due to the broader definition of the disease adopted in this research.
Unhealthy Diet and Lifestyle: Major Contributors
The surge in diabetes cases in India is largely attributed to changing lifestyle factors. Unhealthy dietary habits, particularly the increased consumption of high-calorie, carbohydrate-rich, and fatty foods, combined with a growing sedentary lifestyle, are the main controllable risk factors. As more Indians turn to processed and sugary foods, the impact on public health is severe, with a significant proportion of the population being affected by obesity, a major precursor to type 2 diabetes.
However, one risk factor that has not received enough attention is tobacco use. According to a WHO report from November 2023, smoking increases the risk of developing diabetes by 30-40%. Nicotine, the addictive substance in tobacco, disrupts insulin production by impairing the function of insulin-producing beta cells in the pancreas. This not only affects insulin secretion but also induces insulin resistance — another key factor in the development of diabetes.
Quitting tobacco, particularly smoking, can significantly reduce the risk of developing diabetes. Moreover, it is also associated with a reduced risk of cardiovascular diseases and other complications in individuals already diagnosed with diabetes. Despite this, tobacco use remains a neglected issue in India’s diabetes prevention strategies.
The Importance of Gestational Diabetes Management
Another crucial aspect in curbing the diabetes epidemic in India is addressing gestational diabetes. This condition, which affects pregnant women, significantly increases the risk of both mother and child developing diabetes later in life. Ensuring proper management of gestational diabetes is essential in reducing the long-term diabetes burden on future generations. Awareness and timely intervention during pregnancy could help reduce the incidence of type 2 diabetes in women who have had gestational diabetes, as well as in their offspring.
The Untreated Diabetes Challenge
One of the most alarming statistics highlighted in the study is that, of the 212 million people with diabetes in India, 133 million remain undiagnosed and untreated. This is a major public health concern, as untreated diabetes can lead to severe complications such as heart disease, kidney failure, blindness, and amputations.
India’s ability to meet the WHO’s 2030 target for diabetes management — which aims for 80% of people with diabetes to be diagnosed and 80% of diagnosed individuals to have good glycemic control — is under serious threat. At present, a significant proportion of India’s diabetic population is either unaware of their condition or lacks access to proper medical care and treatment.
The Way Forward: Diagnosis and Public Health Interventions
To address this growing crisis, India must urgently scale up efforts to diagnose and treat diabetes. Widespread screening programs, particularly for at-risk populations, must be prioritized to identify individuals with undiagnosed diabetes. Public health campaigns focusing on diet, exercise, and smoking cessation are also essential in reversing the trend of increasing diabetes cases.
Moreover, improving access to affordable diabetes medication and insulin therapy is critical to ensure that those diagnosed can effectively manage their condition. Strengthening healthcare infrastructure, especially in rural and underserved areas, will be crucial in reaching the millions who remain untreated.
India’s diabetes epidemic is a public health emergency that requires immediate attention. The country has the highest number of diabetes cases globally, with a significant portion of these cases remaining untreated. Addressing the root causes — including poor diet, lack of physical activity, tobacco use, and inadequate medical care — alongside scaling up diagnosis and treatment, will be key to reversing the trend and meeting global health targets.
As the diabetes burden grows, the importance of early detection, lifestyle changes, and timely medical interventions has never been clearer. With focused efforts, India can curb the rising tide of diabetes and improve the quality of life for millions of people affected by this chronic condition.
