India’s Growing Diabetes Crisis: A Conversation with Dr. Pankaj Soni
By Arunima Rajan
In India, diabetes isn’t just a medical condition; it’s a cultural phenomenon. Dr. Pankaj Soni, principal director of internal medicine at Fortis Escorts, New Delhi, doesn’t mince words: “India is the world capital of diabetes,” he says, flatly. Despite increasing awareness campaigns by the government and the healthcare sector, the disease continues to escalate, fueled by modern, urban lifestyles, the proliferation of processed food, and environmental stressors like pollution.
According to The Lancet, nearly one-fourth of the 828 million people living with diabetes worldwide are in India. But the grimmer statistic is this: of the 445 million adults globally denied proper care, 133 million live in India. This means almost 30 percent of diabetics in India lack access to adequate treatment.
That 133 million Indians with diabetes are without adequate care isn’t just a statistic—it’s a public health indictment. This shortage of treatment is a ticking time bomb, piling pressure on an already stretched healthcare system and leaving rural regions woefully under-resourced for chronic illnesses like diabetes. Without targeted action—affordable treatment, real infrastructure in underserved areas, and practical, community-based support—millions will continue to live without the care they need. It’s a stark reminder that India’s diabetes crisis isn’t merely a medical issue; it’s a challenge to how we think about healthcare in this country.
India’s approach to diabetes care under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) is ambitious on paper, addressing prevention, early diagnosis, and standardized management. Launched in 2010, it promises lifestyle interventions, broad screenings, and access to essential medications. So far, about 589 million people are registered on the national NCD portal, and 45.6 million are under treatment for diabetes and hypertension. It’s a nationwide effort, covering 31 states and union territories, with guidelines and trained personnel in place. But the question remains: Can this programme, however vast, outpace the escalating tide of diabetes in India?
World Diabetes Day, observed on November 14 in honor of Sir Frederick Banting, who co-discovered insulin in 1921, highlights the urgent need to tackle the diabetes crisis. What began as a life-saving discovery has now collided with a global health crisis, especially in India, where diabetes places a severe burden on both individuals and the healthcare system.
“Sure, awareness has improved diagnosis,” Dr. Soni acknowledges, “but lifestyle shifts — obesity, stress, pollution — are pushing more people toward diabetes every day.” And for a large, corporate hospital like Fortis, managing diabetes care across a diverse patient base is daunting. People come in from all walks of life, with different needs, awareness levels, and financial means. The reality is, diabetes is a chronic condition, a long-term financial burden that requires constant monitoring and checkups, which few can afford.
The Economic Burden of Diabetes Care
Diabetes isn’t just a chronic disease; it’s a chronic expense. “Newer, more effective treatments are often out of reach for the average Indian,” Dr. Soni says, noting the high cost of patented drugs. Thankfully, affordable generic drugs and insulins from Indian pharma companies have made a difference. But for a significant portion of India’s diabetic population, even generics remain expensive. Dr. Soni suggests it’s time the government and private sector consider subsidizing these costs, especially for lower-income patients.
Expanding Diabetes Awareness and Prevention in Communities
Dr. Soni advocates for a new approach: take diabetes education and preventive care into communities. “We need community-based interventions that incorporate nutrition, exercise, and self-management skills,” he says. Hospitals and clinics should consider building teams specifically trained in lifestyle medicine — people who can go out into communities, raise awareness, and, ideally, prevent diabetes cases from ever entering their doors.
Precision Medicine and AI: Game-Changers on the Horizon
In the battle against diabetes, precision medicine and AI offer hope. By tailoring treatments based on genetic and metabolic markers, precision medicine can effectively target patients, especially those with monogenic diabetes. “Precision medicine helps us get specific,” Dr. Soni says, “It’s about matching treatment to the person’s biology.”
AI, meanwhile, is poised to transform how we manage diabetes altogether. “Imagine a future where AI predicts diabetes, handles contactless screenings, and even recommends dietary or exercise tweaks based on real-time data,” Dr. Soni envisions. Yet, while AI’s promise is immense, Dr. Soni admits there are still significant issues to address, especially around bias and data availability.
Prevention: The Only Way Forward
For Dr. Soni, one truth is clear: treatment is only part of the answer. “We’re stretching healthcare resources to their limit, both in India and abroad,” he warns. The real goal should be prevention. Surprisingly, India hasn’t yet formalized a curriculum for lifestyle disease medicine, an oversight Dr. Soni finds baffling. “Hospitals should be creating
lifestyle medicine departments focused on prevention, so we can get ahead of diabetes before it hits the bloodstream.”
Balancing Traditional and Modern Medicine
Alternative therapies, from Ayurveda to acupuncture, hold a strong appeal for many Indians. But Dr. Soni insists on a balanced approach. “These treatments have their place,” he says, “but they also come with risks.” It’s critical, he notes, for traditional and modern practitioners to work together, ensuring that alternative therapies don’t compromise established treatments.
Bridging the Urban-Rural Divide
Urban hospitals, with their state-of-the-art resources, must also reach into rural areas, where healthcare remains a distant dream. Dr. Soni suggests telemedicine, health camps, and training local “health ambassadors” as starting points. “The technology is there; all we need is a sense of responsibility,” he says.
The Policy Shift India Needs
Finally, Dr. Soni calls for new policy norms that recognize India’s deep socioeconomic and cultural divides. Precision technology and AI could help reduce these gaps, he believes, if policies support accessible, affordable healthcare for all. “Research into affordable drugs and diagnostics can make a ‘Made in India’ healthcare system that works,” he says, envisioning a future where basic healthcare needs aren’t a privilege.
On this World Diabetes Day, November 14, India’s diabetes crisis is more than a statistic—it’s a silent emergency. As Dr. Soni points out, tackling this problem isn’t just about medicine; it’s about rethinking how we handle healthcare, prevention, and access in a country as vast and varied as ours. Today isn’t just a reminder but a call for something far more radical: for communities, policymakers, and the healthcare system to step out of their silos and address diabetes as the chronic, nationwide challenge it is. India has a rare chance to confront this crisis head-on, to create a system that does more than treat—one that prevents, reaches, and works for everyone.