Higher income, better education, and obesity were all linked to increased diabetes risk. Diabetes prevalence among obese individuals was 34.6 per cent, compared to just 7.3 per cent among the underweight.

A new nationwide study has revealed a startling picture of the diabetes epidemic gripping South India, where nearly one in three adults aged 45 and older are living with the disease. Published in The Lancet Global Health, the study is the most detailed mapping of diabetes prevalence in India to date and warns of a growing health crisis driven by economic growth, ageing demographics, and serious gaps in healthcare delivery.

Drawing on data from nearly 58,000 individuals across India as part of the Longitudinal Ageing Study in India (LASI), the research shows that diabetes prevalence is particularly severe in the southern states of Kerala, Puducherry, Tamil Nadu, and Karnataka.

South India’s Burden

Kerala and Puducherry top the chart with an age-adjusted diabetes prevalence of 36 per cent, closely followed by Tamil Nadu and Karnataka. Tamil Nadu alone accounts for over 6 million people aged 45 and older living with diabetes.

Nationally, the study estimates that 19.8 per cent of Indians aged 45 and above –  approximately 5.04 crore people – have diabetes. But in urban areas, the figures are even more worrying: prevalence stands at 30 per cent, double the rate in rural India (15 per cent).

“These numbers are deeply concerning,” said the study’s lead authors. “They reflect a broader pattern where economic and lifestyle transitions are fuelling a rise in chronic diseases like diabetes, particularly in wealthier and more urbanised regions.”

The ‘Prosperity Paradox’

Perhaps the most striking aspect of the study is what researchers call the “prosperity paradox” – a strong positive correlation between a state’s economic development and diabetes prevalence. In simple terms, the more economically advanced a state, the higher its diabetes burden.

Higher income, better education, and obesity were all linked to increased diabetes risk. Among obese individuals (those with a BMI of 25 kg/m² or more), diabetes prevalence was 34.6 per cent, compared to just 7.3 per cent among the underweight. Similarly, those with secondary education or higher had nearly double the diabetes prevalence (29.2 per cent) of individuals with no formal education (15.1 per cent).

“India’s states are in very different phases of the nutrition and health transition,” the authors said. “We see a consistent pattern where higher socioeconomic groups are currently at greater risk, due to more sedentary lifestyles and increased consumption of calorie-rich foods.”

A Hidden Epidemic

One of the most alarming findings is the lack of awareness among people living with diabetes. The study found that 40 per cent of individuals with the disease – about 20 million people – don’t know they have it.

Even among those who are aware of their condition, disease management is poor. Only 46–60 per cent achieve glycaemic control, 28–59 per cent have their blood pressure under control, and just 6–7 per cent take lipid-lowering medications such as statins.

“This shortfall in awareness and treatment leaves millions at risk of devastating complications, including kidney failure, heart disease, and blindness,” the researchers noted.

The findings are a setback to India’s progress toward the World Health Organization’s Global Diabetes Compact targets for 2030, which aim for at least 80 per cent of diabetes cases to be diagnosed, and 80 per cent of those diagnosed to achieve glycaemic control.

As of now, only one state – Arunachal Pradesh – has met even one of the WHO’s four recommended targets, and only for glycaemic control (HbA1c <8.0 per cent) among diagnosed cases.

Ageing India, Growing Crisis

The LASI study focused specifically on middle-aged and older adults, highlighting the looming risk India faces as its population continues to age. With rising life expectancy and declining birth rates, the number of older adults with chronic conditions is set to surge.

“India is rapidly ageing, and with that, the burden of non-communicable diseases like diabetes will increase,” the researchers warned. “Even if we halt the rise in age-specific prevalence, the sheer growth in the number of older adults will drive up total cases.”

This demographic shift has serious implications not just for health systems but for India’s economy. The researchers warn that untreated or poorly managed diabetes among working-age adults can lead to shortened life expectancy, increased disability, and reduced economic productivity.

Better Data, Better Policies

A key strength of the study lies in its methodology: it used HbA1c measurements – a reliable marker of long-term blood glucose levels – rather than relying on self-reported diagnoses. This allows for a more accurate picture of the true scale of diabetes in India.

The researchers also emphasise the need for state-specific policy responses, given the wide variation in prevalence and care across states. With health largely managed at the state level in India, national coordination will be crucial to ensuring equitable access to care.

“The Indian health system is decentralised,” the study notes, “so tailored policies for each state, coupled with effective coordination mechanisms, are vital.”

The report underscores the importance of regular, population-based health surveys to track progress and ensure accountability. The LASI data was collected between 2017 and 2019, immediately before and during the COVID-19 pandemic – a period that significantly disrupted healthcare services.

“Future studies are needed to understand the impact of the pandemic on diabetes care in India,” the authors said.

Growing Diabetes Epidemic

India’s growing diabetes epidemic is not just a medical issue – it’s a national development challenge. The researchers urge policymakers to treat diabetes as a public health emergency requiring improved screening, public awareness, better access to treatment, and preventive lifestyle interventions.

“This is a crucial opportunity,” they said. “If India acts now, it can avoid the worst outcomes of this epidemic. But delay will come at a high cost – for individuals, communities, and the nation as a whole.”

Key Facts at a Glance:

• 19.8 per cent of Indians aged 45+ have diabetes
• Kerala & Puducherry: Highest prevalence at 36 per cent
• 40 per cent of diabetes cases are undiagnosed
• Only 6 to 7 per cent of diagnosed patients use lipid-lowering medication
• Obese adults: Diabetes prevalence at 34.6 per cent
• Urban prevalence: 30 per cent, compared to 15 per cent in rural areas
• WHO 2030 targets unmet in nearly all states

As India stands at a crossroads of economic advancement and public health, this study serves as a wake-up call – one that can’t be ignored.

Image: Wikimedia