India's Diabetes Epidemic- What Can We Do? A Diabetologist's Quest.
- drdeepakchaturvedi
- Mar 23
- 5 min read
Updated: Mar 24
India, often referred to as the "Diabetic Capital of the World," is grappling with an unprecedented diabetes epidemic. With over 101 million people diagnosed with diabetes and another 136 million at risk of developing it (pre-diabetes), the country faces a public health crisis of staggering proportions. As a diabetologist who sees diabetes cases on a daily basis, I am sharing some insight from my clinical experience and the feedback gathered from my patient interactions, the obvious yet overlooked reasons behind this national epidemic, the challenges in managing diabetes, and how we can address this silent killer effectively together.
Why is India the Diabetic Capital of the World?
The high prevalence of diabetes in India is because of a combination of genetic predisposition and rapid lifestyle changes. Indians are genetically more prone to insulin resistance, and this vulnerability is further exacerbated by:
Urbanization and Sedentary Lifestyles: Migration to cities has led to reduced physical activity and increased consumption of calorie-dense foods.
Dietary Shifts: Urban residents consume significantly more energy from animal fats (32%) compared to rural residents (17%), contributing to obesity and metabolic disorders.
Early Onset: Lifestyle changes occur earlier in life, making chronic complications more common over time.
Additionally, diabetes is no longer limited to affluent urban populations. It is increasingly affecting people in rural areas and smaller towns due to changing dietary habits, stress, and lack of awareness.
The Challenges: Why Do Indians Delay Seeking Medical Help?
1. Lack of Awareness
Over 50% of Indians with diabetes remain undiagnosed, leading to delayed treatment and complications. Many are unaware of early symptoms like frequent urination, excessive thirst, fatigue, or blurred vision.
2. Cultural and Social Factors
Stigma: Diabetes is often seen as a personal failure rather than a medical condition, discouraging people from seeking help. Most often, the first feedback the patient gets from friends and family is, "You have been eating too many sweets.", You dont have control over your sugar intake." "It's because of your poor lifestyle." or "You can't keep a check on your diet." "You can't control your tongue and cravings for sweets." These are real incidents shared by my patients who started diabetes treatment after progression when I asked them why they did not come earlier for a diabetes evaluation. Such statements are detrimental to the patient's confidence, and they revolt by ignoring the warning signs in response to these condescending, criticizing and judgemental statements.
Reliance on Alternative Remedies: Whenever these patients suspect diabetes, most of them would actually turn to unproven herbal or traditional treatments suggested by friends, family, unqualified online influencers or an advertisement for a natural anti-diabetic supplement instead of consulting a qualified physician. While some herbs may help manage blood sugar levels, they cannot replace evidence-based medical care.
3. Economic Barriers
The cost of managing diabetes can be prohibitive for many families, especially in rural areas where healthcare access is limited. This is also a very important factor when it comes to managing diabetes. The average annual expenditure on type 2 diabetes care is approximately ₹20,000 per patient, with lifetime costs exceeding ₹5 lakhs. Most patients think that early diagnosis of diabetes means lifelong prolonged expenses on medications and their management underestimating the severity of the long-term side effects of poor diabetic control. Delaying diabetes screening leads to significantly higher costs due to complications of uncontrolled diabetes that could have been avoided with early diabetes identification and proper medical management.
4. Fear and Denial
Many individuals fear lifelong medication or insulin therapy and avoid screenings altogether. This denial often leads to late-stage diagnoses when complications have already set in. Often, patients think that oral medications and injections, such as insulin and other advanced therapies, are not really important to manage diabetes and that they can manage it by diet alone. The sense of mistrust in the healthcare system & heroism is very common among the patients. The preconceived notion is that every diabetic has to take injections if they start medical treatment with a physician. This increases apprehension and fear of taking regular injections, and the problem becomes even more serious.
The Consequences of Delayed Diagnosis
Diabetes is a progressive multisystemic disease that silently damages multiple organs over time if left unmanaged. Common complications include:
Cardiovascular Diseases: Adults with diabetes have a 2–3 times higher risk of heart attacks, especially silent heart attacks and strokes.
Kidney Failure: Diabetes is one of the leading causes of chronic kidney disease in India.
Blindness: Diabetic retinopathy affects up to 16.9% of diabetic patients under 50 years old.
Limb Amputation: Neuropathy and poor wound healing increase the risk of foot ulcers and amputations.
These complications not only reduce life expectancy but also impose a significant financial burden on families and the healthcare system and lead to poor quality of life.
The Role of Herbal Medicines in Diabetes Management
Another common response I get from my patients when asked a question about why they did not see a physician till now is, "I was trying a herbal supplement and some home-based remedies." So it's important to discuss this topic as well. To me, it seems self-medication with herbal meds is one of the most important reasons why patients end up delaying conventional medical treatment with a specialist unless it's too late or the symptoms are unbearable.
Prevalence
A significant number of Indians use herbal medicines for diabetes management—studies estimate usage rates between 58% and 67%. Popular remedies include Indian blackberry seeds (Jamun), Cinnamon bark (Daal-Chini), Fenugreek seeds (Methi), Bitter gourd juice (Karela), Guduchi stem juice (Giloy) and many more herbs.
Risks
While some herbs show promise in managing blood sugar levels, their long-term use carries risks:
Delayed Treatment: Over-reliance on herbal remedies often delays necessary medical intervention, worsening complications.
Hypoglycemia: Combining herbs with conventional medications can dangerously lower blood sugar levels.
Liver dysfunction: Herbal medicines have been associated with liver injury, known as herb-induced liver injury (HILI).
Kidney dysfunction: Certain herbal supplements contain nephrotoxic compounds that have been linked to renal toxicity, chronic kidney disease (CKD), and kidney damage
Gastrointestinal complications: Some herbs may cause GI Tract irritation, nausea, vomiting, diarrhea, abdominal pain or affect the absorption and efficacy of medications.
Adulteration of natural supplements: Often, some OTC herbal supplements on testing are found to have prescription drugs, heavy metals and synthetic steroids.
Lack of Standardization: Variability in herbal products' potency can lead to unpredictable outcomes and interactions with concomitant prescribed medicines.
Patients must always consult healthcare providers before using any herbal medicine to avoid adverse effects or drug interactions, particularly when they are already taking medications for a medical or surgical ailment.
How Can We Improve Awareness?
1. Early Detection Campaigns
Community-level screening programs such as home-to-home or screenings at high schools can help identify high-risk individuals early. Blood glucose checks should be made accessible in workplaces, schools, and community centers.
2. Public Education
Awareness campaigns should focus on recognizing early symptoms such as:
Frequent urination
Excessive thirst
Unexplained weight loss or weight gain.
Fatigue
Blurred vision
Slow-healing wounds
Unexplained infections and inflammation.
Families should be encouraged to monitor these signs at home.
3. Addressing Stigma
Healthcare providers must develop open communication with patients to reduce fear and stigma around diabetes diagnosis and treatment.
4. Affordable Healthcare Access
Subsidized diagnostic tests and medications through public, government and non-government organizations can ease the economic burden for low-income families.
A Call to Action.
India's diabetes epidemic is a silently ticking time bomb that requires urgent attention. Delayed diagnosis and management not only lead to severe health complications but also strain families emotionally and financially. By improving awareness, addressing cultural barriers, and promoting early detection, we can curb this silent killer's impact on millions of lives.
As a diabetologist witnessing this crisis daily, I urge every household to act proactively—understand the risks, recognize the symptoms, seek timely medical help, and adopt healthier lifestyles. Together, we can rewrite India's story from being the "Diabetic Capital" to becoming a model for effective diabetes management worldwide.
Regards
Dr. Deepak Chaturvedi, MD, Internal Medicine
Diabetes, Thyroid, Hormones & Obesity Consultant
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