India's 212 Million Diabetes Cases: How Genetics, Food and Urban Growth Fuelled a Health Crisis

A quarter of the world's diabetes cases are in India

An estimated 212 million people in India were living with diabetes in 2023, according to a major study published in The Lancet. That puts roughly one in four of the world's diabetes cases in India, a total greater than those of China and the United States combined. The number of Indians living with the disease has increased eightfold since 1990.

By September 1, 2025, diabetes had become a public health crisis stretching from crowded cities to rural villages, affecting people across age groups and economic backgrounds. Public health experts warn that its scale could undermine India's development for decades through illness, disability, medical spending and lost productivity.

Genetic susceptibility, a shift towards processed foods and rapid urban growth have combined to increase the risk. People who appear slim can still carry dangerous amounts of fat around their internal organs, while less active routines make it harder for the body to control blood sugar.

The Indian Council of Medical Research (ICMR) estimates that more than 100 million Indians have diabetes and another 136 million have pre-diabetes, a condition in which blood sugar is higher than normal and often progresses to diabetes within five years. The Lancet study's estimate of 212 million and ICMR's figure of more than 100 million both describe an enormous burden; the reason for the gap between those estimates was not given.

For families, the consequences extend beyond a diagnosis. Diabetes can damage eyesight, kidneys, nerves and the heart. Earlier diagnosis also means more years spent managing the disease, making prevention, screening and continuing treatment central to the response.

What happens when the body cannot control blood sugar?

Type 2 diabetes accounts for 95% of cases. It develops when the body does not produce enough insulin or becomes resistant to it. Insulin helps regulate blood sugar; when it cannot do its job effectively, sugar remains at persistently high levels in the blood.

High blood sugar gradually damages blood vessels and nerves. Diabetes shortens life expectancy by an average of seven years and is a leading cause of blindness, amputations, kidney failure, heart disease and stroke in India. Complications are also appearing in teenagers and children.

Pre-diabetes offers an opportunity to act before diabetes develops, but the transition can be rapid. Dr. RM Anjana, lead author of the landmark Lancet study, described the speed of progression in the Indian population:

Pre-diabetes often converts to diabetes very quickly in the Indian population, with more than 60% converting within five years.

That pace makes early testing and changes to daily habits particularly important. Waiting until someone feels seriously unwell can mean discovering the disease after damage has already occurred.

Why South Asians face greater risk at lower body weights

People of South Asian descent are four to six times more likely to develop diabetes than other ethnicities, and they often develop it at lower body weights. Part of that vulnerability concerns where the body stores fat, rather than simply how much a person weighs.

Visceral fat collects around organs such as the liver and pancreas. It increases insulin resistance, making blood sugar harder to control. A person can therefore look slim by Western standards while carrying abdominal fat that puts their health at risk.

The National Family Health Survey found abdominal obesity in about 40% of Indian women and 12% of men. Those figures show why visible body size alone can leave people unaware of their vulnerability.

Scientists have not identified a single gene responsible for India's heightened susceptibility. One explanation connects present risks with the country's history of frequent famines and undernutrition: a tendency to store fat efficiently may have helped people survive food shortages, while becoming a disadvantage when food became more abundant.

Research published in Frontiers in Public Health suggests that low birth weight, short stature and low lean muscle mass, common in Indian populations affected by historical ecological stresses, have reduced metabolic capacity. In simple terms, the body may have less capacity to cope with the demands created by modern diets and lifestyles.

That helps explain susceptibility to obesity and diabetes at lower body mass indexes (BMIs), a measure relating weight to height. Undernutrition across generations may also influence risk through epigenetic changes, which affect how genes function. Historical famines are among the experiences considered in this explanation.

How changes in food and cooking contribute

Traditional Indian diets once relied more heavily on whole grains, legumes and vegetables. Over recent decades, refined carbohydrates and processed foods have taken a larger place on the plate. Genetics creates vulnerability, while changes in diet and daily activity help turn that vulnerability into disease.

The Green Revolution and subsequent government policies promoted the cultivation and consumption of high yielding grains, including rice and wheat, consumed in refined forms such as white rice. Traditional staples such as millet and barley were displaced. Refined carbohydrates have a higher glycemic index, meaning they can cause blood sugar to rise more quickly.

The World Health Organization says sales of ultra-processed foods in India have grown by 13% annually since 2011. Fast food chains and multinational brands have expanded access to sugary drinks, fried snacks and other processed products. Rising incomes and convenience have encouraged more eating out and less reliance on food prepared at home.

An ICMR study also examined Advanced Glycation End Products (AGEs), harmful compounds formed during cooking at high temperatures and food processing. Foods such as samosas, chips, cakes and fried products can contain high levels. AGEs promote inflammation, oxidative stress and insulin resistance, processes that make it harder for the body to manage blood sugar.

Oxidative stress describes damage associated with harmful chemical reactions in the body. Alongside inflammation, it helps explain why researchers are examining cooking methods as well as the amount and type of food people eat.

In the ICMR clinical trial, participants who changed to a diet low in AGEs, including fruits, vegetables, whole grains and foods prepared by boiling or steaming, showed improved insulin sensitivity and lower blood sugar. Participants consuming diets high in AGEs experienced greater inflammation and higher diabetes risk. The findings connect food preparation with the broader effort to improve diets.

Urban growth is changing daily routines

India's urban population has grown from 18% in the 1960s to about 35%, with the share projected to reach 40% by 2030. More people now live in settings where sedentary work, reduced physical labour and readily available processed food shape everyday life.

Diabetes prevalence is 14.9% in urban areas, compared with 9.5% in rural regions. That is a difference of 5.4 percentage points. Cities face a heavier burden, while the rural figure shows that the disease is already widespread beyond them.

Economic growth has changed how people work and eat. More Indians spend their working hours sitting, eat convenience foods and dine out. These changes are particularly pronounced among the growing middle class, but rural populations are adopting similar habits as processed products become easier to obtain.

Several milestones show how the pressures have accumulated:

• In the 1960s, 18% of Indians lived in urban areas.
• Since 1990, the number of people living with diabetes has increased eightfold.
• Since 2011, sales of ultra-processed foods have grown by 13% annually, according to the World Health Organization.
• In 2023, the Lancet study estimated that 212 million Indians had diabetes.
• By 2030, India's urban population share is projected to reach 40%.

Smoking, pregnancy and regional differences add to the burden

Smoking increases diabetes risk by 30% to 40%, according to the World Health Organization. Nicotine impairs insulin production and promotes insulin resistance, adding another source of pressure on blood sugar control. Chronic stress, air pollution and exposure to environmental toxins have also been linked to higher diabetes rates.

Gestational diabetes, which develops during pregnancy, creates risks for two generations. Women who experience it are more likely to develop type 2 diabetes later, and their children are also more susceptible. Managing diabetes during pregnancy and supporting healthy pregnancies are therefore part of efforts to reduce risk across generations.

Goa, Puducherry and Kerala report the highest prevalence, while Uttar Pradesh and Bihar, previously places with lower prevalence, are seeing sharp increases. The geographic spread means health services must respond in areas with different levels of experience and resources.

In Karnataka, 12% of adults have diabetes, with diagnoses increasingly occurring among people as young as 25. Developing the disease earlier means living with it for longer, increasing the opportunity for complications to develop and extending the need for regular care.

The human cost includes lost sight, kidney damage and disability

Diabetes kills around 1.6 million Indians each year. Its effects can develop gradually, leaving people managing several health problems at once. Persistently high blood sugar damages the small vessels that supply organs as well as the nerves and circulation needed to keep feet healthy.

Diabetic retinopathy occurs when blood vessels in the retina, the light sensitive tissue at the back of the eye, are damaged. It is a leading cause of vision loss. A 2022 study found signs of diabetic eye disease in 12.5% of Indians with diabetes, equivalent to one in eight.

Kidney damage can progress to chronic kidney disease and the need for dialysis. Nerve damage and poor circulation can allow foot ulcers and infections to develop, sometimes leading to amputation. Such complications are increasingly being seen in younger patients. Diabetes also greatly increases the risk of heart disease and stroke.

Families face medical bills alongside lost earnings, reduced productivity and disability that can last for years. Billions are spent on these consequences. The World Economic Forum estimates that global health expenditure on diabetes could reach $1 trillion by 2045, with developing countries such as India carrying the greatest burden.

Why diagnosis and continuing care remain difficult

Nearly 57% of Indians with diabetes are unaware that they have it, according to the latest figures cited for the crisis. Many seek medical care only when complications appear, after the disease has already caused irreversible damage.

Limited routine screening, particularly in rural areas, helps explain the diagnosis gap. Affordable healthcare and diagnostic tools are also difficult for many people to access. A condition requiring repeated checks and continuing treatment creates demands that extend well beyond the first blood test.

Government initiatives include expanding screening for adults over 30, subsidising essential medicines and blood sugar monitors, and sending healthcare teams to rural areas to train staff in diabetes care. The stated goal is to reach at least 75 million people with diabetes or at risk of developing it by the end of 2025.

For people already diagnosed, controlling blood sugar, blood pressure and cholesterol can prevent or delay complications. Early detection works best when followed by consistent management, so that people can obtain treatment and keep returning for care.

Prevention policies and cheaper medicines are part of the response

Taxes on sugary drinks and processed foods are attracting interest as possible prevention measures, drawing on successful interventions in Mexico and the UK. Revenue could support public health campaigns and make healthier food more affordable through subsidies.

Policymakers also face cultural preferences for sweets and the need to avoid placing a disproportionate financial burden on people with low incomes. Schools and community programmes are being encouraged to promote healthier eating, physical activity and stress management from childhood.

Semaglutide, the active ingredient in Ozempic, offers another possible route to wider treatment. The medicine improves blood sugar control and promotes weight loss. It is expected to become much more affordable in India when patent protection ends, with prices potentially falling by as much as 90%.

Medication forms one part of a response that also involves diet, physical activity, screening and access to care. Dr. H Basavanagowdappa, vice-chancellor of JSS Academy of Higher Education & Research, described the challenge:

The reality is that it's a multifactorial problem without a quick solution.

Multifactorial means that several causes act together. India's diabetes burden combines inherited vulnerability, conditions early in life, changing food habits, less physical activity and barriers to treatment. Addressing those pressures requires sustained work across health services, food policy, schools and communities.

What people can do to reduce their risk

Genetics and early life experiences cannot be changed, but many diabetes risk factors can. Recommendations focus on daily habits that reduce pressure on blood sugar control and on testing that can identify problems before complications develop.

A diet built around whole grains, fruits, vegetables and lean proteins can replace some processed, fried and sugary foods. Boiling and steaming instead of frying or roasting can reduce AGEs. These choices address both the ingredients people eat and the way meals are prepared.

Regular physical activity is another priority, with a recommendation of at least 150 minutes of moderate exercise each week. Avoiding tobacco in all forms, limiting alcohol and managing stress through mindfulness, yoga or other relaxation techniques are also recommended.

Regular health checks are particularly valuable for people with a family history of diabetes or other risk factors. For those already living with the condition, continuing treatment and monitoring can help protect sight, kidneys, feet and cardiovascular health. Prevention and good care need to proceed together.

Key Points

• A Lancet study estimated that India had 212 million people with diabetes in 2023, roughly a quarter of the global total.
• ICMR estimates more than 100 million people have diabetes and another 136 million have pre-diabetes.
• Genetic susceptibility, historical undernutrition, dietary changes and less active routines contribute to the crisis.
• Diabetes prevalence is 14.9% in urban areas and 9.5% in rural regions.
• Nearly 57% of Indians with diabetes are unaware of their condition.
• Complications include blindness, kidney failure, amputations, heart disease and stroke, including among younger patients.
• Government measures include screening adults over 30 and a goal of reaching 75 million people with diabetes or at risk by the end of 2025.
• Healthier diets, physical activity, tobacco avoidance, early testing and consistent treatment are central to reducing harm.