India’s diabetes burden has reached alarming levels, with a recent Lancet report showing that approximately a quarter of all adults with diabetes worldwide are Indian. Of the estimated 828 million global cases, 212 million are in India alone, making it the leading nation in diabetes prevalence, ahead of countries like China (148 million), the US (42 million), Pakistan (36 million), Indonesia (25 million), and Brazil (22 million).
Study insights and methods
The study, conducted by the NCD Risk Factor Collaboration (NCD-RisC) and WHO, presents a global analysis of diabetes trends using data from over 140 million adults across more than 1,000 studies. Researchers assessed diabetes prevalence based on fasting plasma glucose (FPG) levels of 7.0 mmol/L or 126 mg/dL and an HbA1c level of 6.5% or above.
Why India’s numbers appear high
Dr. R M Anjana, president of the Madras Diabetes Research Foundation and study author, noted that India’s diabetes count has risen significantly due to the HbA1c test used in the study. Earlier, the ICMR-INDIAB study measured diabetes prevalence with the Oral Glucose Tolerance Test (OGTT), which is highly accurate and even detects prediabetes. However, the Lancet study’s reliance on HbA1c—which can be affected by factors like anaemia and certain medications—may have led to inflated numbers. Top diabetologist Dr. C S Yajnik highlighted that conditions like anaemia and iron deficiency, prevalent in India, can falsely elevate HbA1c readings, resulting in potential misdiagnoses. Consequently, excluding HbA1c, India’s diabetes prevalence in 2022 was lower, at 14.4% (69 million) in women and 12.2% (62 million) in men, totaling 131 million.
Key risk factors
Globally, obesity and poor diet are major diabetes risk factors. In India, lower-income regions face unique challenges due to limited access to healthy foods and safe spaces for physical activity. Dr. Anjana emphasized the need for policies targeting affordable healthy diets, restricting unhealthy food options, and promoting accessible exercise facilities to combat diabetes risk.
Treatment gap and healthcare challenges
The Lancet study highlights a critical treatment gap: in 2022, 59% of adults over 30 with diabetes remained untreated globally—an increase from 129 million in 1990 to 445 million in 2022. In India, nearly 64 million men and 69 million women had untreated diabetes. The lack of treatment is concerning as, without intervention, individuals face risks of severe complications, including amputations, heart disease, kidney damage, vision loss, and even premature death.