Samaan Lateef | New Delhi
India now accounts for a staggering quarter of the world’s adult diabetic population, with 212 million of the global 828 million diabetics residing in the country, according to a landmark *Lancet* report released on World Diabetes Day. The study highlights that India leads globally in diabetes prevalence, surpassing nations like China (148 million) and the United States (42 million). It reveals a growing health crisis in South Asia, driven by complex socio-economic factors and challenges in healthcare delivery.
The research, conducted by the NCD Risk Factor Collaboration (NCD-RisC) in partnership with the World Health Organization (WHO), is the first global analysis to comprehensively examine diabetes trends alongside treatment data. Using data from over 141 million people across more than 1,000 studies, the findings rely on two widely accepted diagnostic criteria: fasting plasma glucose (FPG) and HbA1c levels. However, the study’s methodology has sparked debates about the accuracy of diabetes prevalence rates in India.
A Disputed Benchmark: Are India’s Diabetes Numbers Overstated?
Top Indian researchers suggest that the diagnostic benchmarks used in the *Lancet* study might inflate diabetes figures for India. Dr. R.M. Anjana, president of the Madras Diabetes Research Foundation and one of the study’s authors, explains that the use of HbA1c as a diagnostic criterion can lead to overestimations. “Our earlier study, the ICMR-INDIAB survey, which used the Oral Glucose Tolerance Test (OGTT), found a significantly lower prevalence of diabetes at 131 million,” she notes.
HbA1c, though widely used, may yield misleading results in populations with anaemia or iron deficiency—conditions prevalent in India. Dr. C.S. Yajnik, a renowned diabetologist, has previously demonstrated how anaemia can elevate HbA1c levels, potentially misclassifying healthy individuals as diabetic. “In regions with high anaemia rates, glucose-based measurements are more reliable,” he asserts.
The Underlying Risk Factors: A Call for Policy Action
India’s diabetes crisis is exacerbated by rising obesity, sedentary lifestyles, and poor dietary habits. Dr. Anjana emphasises the need for urgent policy interventions: “We must promote affordable healthy food options, regulate unhealthy foods, and create safe spaces for exercise, especially in lower-income areas. School meal programmes and free access to parks and fitness centres are vital steps.”
Alarming Treatment Gaps
India also leads globally in untreated diabetes cases, with 133 million adults living without essential medication in 2022—more than half of the country’s diabetic population. Untreated diabetes increases the risk of severe complications, including heart disease, kidney failure, vision loss, and even premature death.
“This is deeply concerning,” says Professor Majid Ezzati, senior author of the *Lancet* study. “People in low-income countries, including India, often develop diabetes at younger ages, which places them at risk of lifelong complications. The absence of treatment worsens the situation.”
Globally, the treatment gap has widened, with 445 million people over the age of 30 living without medication in 2022—a staggering 3.5-fold increase since 1990. India’s untreated diabetes burden is disproportionately high compared to nations like China, which has better treatment coverage.
A Growing Divide in Global Diabetes Care
The study underscores a widening global disparity in diabetes prevalence and treatment. While high-income countries have seen significant improvements in treatment coverage, low- and middle-income countries, including India, face rising diabetes rates with limited healthcare access.
The report serves as a critical call to action for Indian policymakers, healthcare providers, and international organisations. Without bold, systemic changes, the country risks a worsening public health crisis, threatening its economic and social development.
