According to the Lancet, global diabetes rates among adults have doubled since 1990, rising from 7% to 14% in 2022. The most significant increase occurred in middle- and low-income countries. Notably, the study found that 60% of people with Type 2 diabetes lived in just six countries, with India accounting for the largest share at 212 million adults. As India’s economy and population have expanded rapidly over the past 35 years, so has the prevalence of Type 2 diabetes, particularly among the nation’s poorest communities.

Demographic Changes

Since 1990, India’s economy and population have surged, making it one of the world’s fastest-growing nations. The country’s economy has grown tenfold, increasing from $320 billion to $3.57 trillion. Meanwhile, its population has nearly doubled, rising from approximately 870 million to 1.42 billion.

The country has also experienced a significant rise in urbanization since 1990, with 519 million urban residents. While these demographic changes suggest economic progress, rapid population growth and urbanization have placed a strain on infrastructure and public services. Without sufficient investments in health care and education, these shifts can potentially widen inequalities, including access to health care. The increasing rates of Type 2 diabetes in India illustrate this challenge.

Since 1990, the number of people in India living with diabetes or classified as pre-diabetic has risen to 237 million as of 2023. Type 2 diabetes occurs when the body fails to use insulin effectively to regulate blood sugar levels. If not diagnosed early or treated properly, complications can include heart and kidney disease, as well as foot and leg amputations.

Challenges in Diabetes Care Across India

Studies reveal that urbanization in India leads to higher consumption of energy-dense foods and reduced physical activity, increasing obesity rates and the risk of Type 2 diabetes and other cardiometabolic conditions. Low awareness of diabetes among India’s adult population underscores the need for better health monitoring and education. Treatment and control rates remain low, particularly in rural areas and among low-income populations, due to barriers to health care access and high treatment costs. Although low-cost glycemic medications are available, many individuals cannot afford them.

With too few trained diabetes educators in India, physicians bear the burden of patient education. Variations in diabetes education standards among universities lead to inconsistent patient education. The absence of national certification requirements and low-quality diabetes training at some universities hinder efforts to regulate diabetes care and education programs.

Disparities in diabetes funding across Indian state governments likely stem from varying awareness levels and the economic burden of diabetes care. Some states allocate significantly more resources to diabetes management than others, highlighting the need for a more standardized national approach. Without sufficient investment in awareness campaigns, medical training and affordable treatment options, diabetes will continue to pose a growing public health challenge in India.

A Hybrid Approach

Since 2010, the Indian government has introduced several measures aimed at increasing diabetes awareness through both physical and technological initiatives. These programs seek to reach as many people as possible, especially in underserved areas.

• National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) – 2010. Launched in 2010, NPCDCS was designed to curb the growing burden of noncommunicable diseases, which had become more prevalent than communicable diseases. The program focuses on prevention, early screening and disease management while improving access to treatment—particularly for low-income populations.
• mDiabetes Initiative – 2011. Developed by Arogya World in collaboration with Nokia, this mobile health initiative delivers text messages on diabetes management in 12 languages. It has reached 130 million people. A follow-up study found that 51.9% of participants underwent diabetes screening and 67.3% monitored their glucose levels. The Indian Ministry of Health later adopted the program, recognizing its success in raising awareness.
• Ayushman Bharat Health and Wellness Centers – 2018. These centers provide comprehensive health care services, including screenings for Type 2 diabetes. The initiative has significantly improved health care infrastructure, with 150,000 wellness centers now operational.
• E-Sanjeevani Telemedicine Service – 2020. Launched by India’s Ministry of Health and Family Welfare, E-Sanjeevani is a telemedicine platform that has facilitated more than 100 million virtual consultations since 2023. The service has played a vital role in bridging the gap between health care providers and patients, particularly for those in poverty who may struggle to access in-person consultations.

Looking Ahead

India’s rapid economic growth has coincided with a surge in Type 2 diabetes, particularly among low-income communities facing limited health care access and education. While urbanization and dietary shifts have contributed to rising cases, the government has implemented multiple initiatives to address the crisis. Programs such as the NPCDCS, mDiabetes, E-Sanjeevani and Ayushman Bharat have improved awareness, screening and access to treatment, especially in rural and underserved areas. However, continued investment in public health care, education and preventive measures could be essential to curb the growing burden of diabetes and ensure equitable health outcomes across all socioeconomic groups.

– Oliver Hedges

Oliver is based in Lancaster, UK and focuses on Global Health for The Borgen Project.

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