Policy Update
Annika Saigal
Introduction
World Diabetes Day is observed every year on 14 November, commemorating the birth anniversary of Sir Frederick Banting, who co-discovered insulin with Charles Best in 1921. The day was established in 1991 by the International Diabetes Federation (IDF) and the World Health Organization (WHO), and was formally recognised by the United Nations in 2006 through Resolution 61/225.
According to the WHO more than 40% of people living with diabetes across the globe are undiagnosed. This year, World Diabetes Day begins a new two-year campaign cycle under the theme “Early Action on Diabetes.” The International Diabetes Federation (IDF) is using the campaign to emphasise early diagnosis and risk reduction,while WHO highlights three closely connected priorities: earlier diagnosis, access to comprehensive care and reducing diabetes stigma. The message is particularly urgent since without diagnosis, people may not receive the treatment, care and support needed to manage the condition and prevent complications [1].
The global diagnosis gap is now accompanied by a measurable policy benchmark. In 2022, WHO Member States endorsed five global diabetes coverage targets to be achieved by 2030, including a target that 80% of people living with diabetes should be diagnosed, while 80% of those diagnosed should have good glycaemic and blood-pressure control. The targets also call for 60% of people with diabetes aged 40 years or older to receive statins, and for all people with type 1 diabetes to have access to affordable insulin and blood-glucose self-monitoring [2].
In the context of India, this year’s theme is highly relevant since the nation has one of the world’s largest diabetes populations, while a substantial proportion of these very cases remain undiagnosed. National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) is India’s principal policy response, which began in 2010 as the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) and was subsequently expanded and renamed to cover a broader range of chronic conditions. Due to health falling under the state subject, the implementation takes place via state health systems with central support under the NHM or National Health MissionThe policy question, therefore, is no longer simply how many people India is screening. It is whether screening is translating into confirmed diagnosis, treatment initiation, sustained follow-up and effective disease control.
This article aims to examine the scale of India’s diabetes burden and how the country’s early-detection system works, what it has achieved, and where gaps between screening and care could limit the impact of the early-action agenda.
The Burden
India’s diabetes burden is actually large, but estimates vary since the major studies use varied age groups, time periods and diagnostic definitions. The principal estimates are mentioned below-
IDF Diabetes Atlas, 11th edition (2025)– about 89.8 million adults aged 20–79 were living with diabetes in India in 2024, corresponding to an age-standardised prevalence of 10.5%. India ranked second globally after China. Around 43%, or approximately 38.6 million people, were estimated to be undiagnosed. The IDF projects that the number of adults with diabetes could reach 156.7 million by 2050. National diabetes-related health expenditure was estimated at more than USD 9.8 billion, or about USD 109.5 per person [4].
ICMR–INDIAB study (2023) which is a nationally representative study covering 113,043 individuals across 31 states and union territories estimated that approximately 101 million people had diabetes and 136 million had prediabetes. Diabetes prevalence varied substantially between states, ranging from 4.8% in Uttar Pradesh to 26.4% in Goa [9].
Global NCD-RisC analysis (The Lancet, 2024) shows a secondary reporting of this analysis estimated approximately 212 million adults with diabetes in India, of whom around 133 million were untreated. This estimate uses a different methodology and age definition and should therefore not be directly compared with the IDF or ICMR–INDIAB figures [8].
The estimates differ in absolute size, but the policy message is very consistent, which is that India has a very large diabetes burden, a substantial diagnosis gap and an even larger population at the risk of developing the disease in the future.
This very future burden is also closely tied to the rising overweight and obesity.
A Lancet analysis in 2025 based on the Global Burden of Disease 2021 study projected that approximately 450 million Indians aged 25 and above could be overweight or obese by 2050, compared with about 180 million in 2021. It is essential to note that the figure combines overweight and obesity and hence should not be interpreted as the number of people living with obesity alone. India is also projected to have the world’s second-largest number of overweight or obese adults, right after China [3].
The IDF likewise projects that India’s adult diabetes population could rise from 89.8 million in 2024 to 156.7 million in 2050, an approximate increase of 75% [4].
These are projections based on models rather than predictions of an inevitable future. Their significance is that they show why diabetes prevention cannot begin only when a person reaches a health facility with symptoms. Hence, it is important to take into consideration that Risk reduction and early detection need to operate before complications develop and, increasingly, before diabetes itself develops.
INDIA’S RESPONSE
India’s response to this challenge lays on a few major components, which are discussed below-
1. Population-Based Screening
Under Population-Based Screening (PBS), people aged 30 years and above are screened for diabetes, hypertension and three common cancers which are oral, breast and cervical.
ASHAs enumerate the eligible population through household visits and use the Community-Based Assessment Checklist (CBAC) to assess individuals for NCD risk. Screening is then supported by Auxiliary Nurse Midwives (ANMs) and Community Health Officers (CHOs) at Ayushman Arogya Mandirs (AAMs) [5]
Diabetes screening using a glucometer is also intended to take place every year.
The model is crucial since it attempts to shift diabetes detection away from an exclusively facility based system. So Instead of waiting for people to present with symptoms or complications, this programme seeks to identify risk and disease within the communities.
2. Ayushman Arogya Mandirs as the Delivery Platform
More than 1.86 lakh upgraded sub-centres and primary health centres function as Ayushman Arogya Mandirs. They are intended to provide screening, follow-up, lifestyle counselling and essential medicines, with referral to higher facilities for confirmatory diagnosis and treatment when necessary.
In principle, this creates a continuum which starts with risk identification, followed by a screening, a confirmation, which is led by treatment and then back to a follow up, which eventually leads us back to disease control.
The challenge here is to ensure that people do not fall out of this pathway after the initial screening.
3. Targets and Financing
In February 2025, the Union Health Ministry launched a nationwide intensified NCD screening drive aimed at 100% coverage of people aged 30 years and above for diabetes, hypertension and three common cancers—oral, breast and cervical—with screening, treatment and follow-up data uploaded daily on the NP-NCD Portal [6].
This builds on the earlier 75/25 initiative, which sought to bring 75 million people with hypertension and diabetes onto standardised care by 2025.
NP-NCD is financed primarily through the NCD Flexi-Pool in state Programme Implementation Plans under the National Health Mission.
Collectively these measures represent a major shift towards systematic community-based detection. But the scale of screening raises a second question which is what follows after a person screens positive.
Beyond the Health Facility
Early action on diabetes cannot be limited to screening since aspects such as diet, physical activity, obesity and the wider environments in which people live and work also shape diabetes risk. India has therefore introduced several prevention measures beyond simply just healthcare delivery, which are discussed below.
Eat Right India and Poshan Abhiyaan
The Food Safety and Standards Authority of India’s Eat Right India movement and Poshan Abhiyaan promote healthier diets and improved nutrition. These initiatives, alongside the Fit India Movement, form part of India’s broader prevention strategy.
Fit India Movement
Launched in 2019, the Fit India Movement promotes physical activity and healthy lifestyles, including through initiatives such as Fit India School Certification.
Reducing Oil and Sugar Consumption
In 2025, the Prime Minister called for a 10% reduction in oil consumption, linking excessive consumption with obesity and related health risks. The government has also promoted sugar and oil boards in schools and government offices to increase awareness of consumption levels.
Front-of-Pack Labelling
Front-of-pack warning labels have been proposed to help consumers identify foods high in sugar, salt and fat. Although such measures have been recommended in India’s NCD policy framework, the status of final regulations has remained subject to ongoing policy developments.
These interventions attempt to address diabetes risk beyond healthcare delivery.
However, most remain awareness and information-based measures, and their direct effect on dietary behaviour and diabetes incidence has not yet been established.
WHO’s 2026 campaign similarly emphasises healthier environments, physical activity, healthy food and access to quality care as part of diabetes prevention [1].
Performance: From Screening to Treatment
India’s programme has generated large administrative outputs. As of February 2026, cumulative screening had crossed 40.68 crore for diabetes and 40.87 crore for hypertension, while approximately 3.39 crore people with diabetes were reported to be on active treatment [7].
These figures demonstrate the scale of the programme but also require careful interpretation. Cumulative screening may include repeat screenings and therefore cannot be treated as the number of unique individuals covered.
Also more importantly, screening, diagnosis, treatment and disease control are different stages of care. The reported 3.39 crore people on treatment is roughly 34% of the ICMR–INDIAB estimate of 101 million people with diabetes and around 38% of the IDF estimate of 89.8 million. These comparisons are illustrative rather than measures of programme effectiveness because the datasets cover different age groups and populations.
A person who has been screened is not necessarily diagnosed; a diagnosed person is not necessarily receiving treatment; and a treated person is not necessarily achieving adequate disease control.
The WHO 2030 targets reflect this distinction by seeking not only 80% diagnosis, but also good glycaemic and blood-pressure control among those diagnosed.
The Quality-of-Care Gap
ICMR–INDIAB data found that only around 36% of people with self-reported diabetes achieved good glycaemic control, while just 7.7% achieved targets for blood sugar, blood pressure and LDL cholesterol. Although these data cover the 2008–2020 study period, they highlight why India’s next phase of diabetes policy must focus on quality and continuity of care, not only coverage [10].
Impact: Why Early Action Matters
India’s national programme has not yet been independently evaluated at scale to establish how much expanded screening has reduced complications or improved long-term glycaemic control. However, the rationale for early action is clear.
Earlier diagnosis can prevent complications
Diabetes can damage the eyes, kidneys, nerves, heart and blood vessels over time. Earlier detection and management can help prevent or delay serious complications. IDF’s 2026 campaign similarly highlights the risks associated with delayed diagnosis, including diabetic ketoacidosis in type 1 diabetes.
Prediabetes provides a prevention window
The ICMR–INDIAB study estimated approximately 136 million Indians have prediabetes, creating a major opportunity to reduce or delay progression to type 2 diabetes. Diabetes prevention therefore needs to begin before diagnosis as well as after it.
Diabetes creates financial and social pressure
Diabetes can impose substantial costs on households, particularly when complications require hospitalisation, dialysis or long-term treatment. Earlier detection and effective management can potentially reduce both health and financial burdens.
The condition also affects working-age populations, while stigma may discourage people from seeking or disclosing care. IDF’s 2026 campaign identifies limited awareness and uncertainty about accessing testing as important barriers to early action.
Emerging Issues
Several structural issues could limit the effectiveness of India’s early-action agenda.
1. Screening is not the same as care
The most important gap lies between screening and sustained treatment. India therefore needs to monitor the full cascade:
screened → screen-positive → confirmed → treated → retained → controlled.
2. The age threshold
Population-based screening begins at age 30, while diabetes is increasingly occurring among younger populations. Risk-based screening before age 30 could therefore be considered for high-risk groups. Type 1 diabetes in children and young adults, however, requires a different detection and care pathway.
3. Drug and diagnostic availability
Screening has limited value if facilities cannot consistently provide confirmatory testing, medicines and follow-up. Availability can vary across states and facilities, while newer therapies remain more accessible through private healthcare.
4. Workforce capacity
The programme depends heavily on ASHAs, ANMs and CHOs, who already manage multiple health priorities. Effective early action therefore requires adequate training, equipment, time and referral support.
5. Data quality and privacy
The National NCD Portal and ABHA-linked systems can improve continuity of care, but their effectiveness depends on accurate data entry, interoperability, privacy, consent and cybersecurity.
6. Upstream risk factors
Diet, physical inactivity, obesity and air pollution extend beyond the health sector. Food regulation, school meals, urban planning, transport and workplace policies can all influence diabetes risk. Early action therefore requires a whole-of-government approach.
7. Stigma and awareness
WHO places stigma directly within the 2026 campaign because it can discourage diagnosis and treatment. The goal should therefore be to create environments where diabetes diagnosis and long-term care are socially supported rather than stigmatised.
Way Forward
The 2026 theme provides an opportunity to shift India’s diabetes strategy from counting interventions to measuring outcomes. Few of the solutions are discussed below.
Close the screening-to-treatment gap
India should report the proportion of screen-positive individuals who are confirmed, started on treatment and retained in care after six and 12 months.
Measure control, not just coverage
State-level reporting should increasingly include the proportion of registered patients achieving adequate glycaemic and blood-pressure control. The ultimate test of screening is whether people are healthier because they entered the system.
Invest in the prediabetes stage
With a large population living with prediabetes, structured lifestyle interventions should be strengthened through AAMs, schools, workplaces and community platforms. Risk-based screening before age 30 should also be evaluated for high-risk groups.
Strengthen primary-care supplies and follow-up
Essential medicines, glucometers, test strips and HbA1c testing should be consistently available. Digital tracking can help identify patients who miss follow-up and prevent people from dropping out of care.
Address upstream drivers
Health, food, education, urban planning and environmental policies should be better coordinated around diet, physical activity, obesity and air quality. Information campaigns alone are unlikely to reverse population-level risk if healthier choices remain inaccessible or unaffordable.
Reduce stigma and strengthen workplace support
Public campaigns should combine information about symptoms and risk with messages about treatment, prevention and acceptance. Workplaces should support employees living with diabetes rather than encouraging concealment.
Strengthen the evidence base
India needs regular, nationally representative surveys using consistent definitions and age groups. This would make it easier to reconcile differing estimates and assess whether increased screening is producing earlier diagnosis, better treatment and improved disease control.
Conclusion
World Diabetes Day 2026 shifts the conversation from awareness to early action, which I believe is the need of the hour. For India, this means more than expanding the number of people screened.
The country has built a large population-based screening infrastructure through NP-NCD and Ayushman Arogya Mandirs. The next challenge is ensuring that people identified through these systems are diagnosed, treated, followed up and brought to effective disease control.
WHO’s 2030 target of diagnosing 80% of people living with diabetes provides a useful global benchmark, while its accompanying targets on glycaemic and blood-pressure control make clear that diagnosis cannot be the endpoint.
For India, therefore, the central test of the “Early Action on Diabetes” agenda will be whether the health system can close the gap between finding diabetes and effectively managing it. The shift required is from measuring how many people were screened to asking how many people were actually helped or benefitted because they were screened.
References
[1] World Health Organization (WHO), “World Diabetes Day 2026: Early action on diabetes,” 14 November 2026.
https://www.who.int/campaigns/world-diabetes-day/2026
[2] World Health Organization (WHO), “First-ever global coverage targets for diabetes adopted at the 75th World Health Assembly,” 28 May 2022.
https://www.who.int/news-room/feature-stories/detail/first-ever-global-coverage-targets-for-diabetes-adopted-at-the-75th-world-health-assembly/
[3] GBD 2021 Adult BMI Collaborators. “Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021.” The Lancet. 2025;405(10481):813–838.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00353-3/fulltext?
[4] International Diabetes Federation (IDF), IDF Diabetes Atlas, 11th edition, 2025.
https://diabetesatlas.org/resources/idf-diabetes–atlas-2025/
[5] Ministry of Health and Family Welfare, Government of India, Module for Multi-Purpose Workers – Prevention, Screening and Control of Common Non-Communicable Diseases.
https://www.mohfw.gov.in/sites/default/files/Module%20for%20Multi-Purpose%20Workers%20-%20Prevention%2C%20Screening%20and%20Control%20of%20Common%20NCDS_2.pdf
[6] Ministry of Health and Family Welfare, Government of India, “Union Health Ministry launches Intensified Special NCD Screening Drive to ensure 100% coverage of all individuals aged 30 years and above,” Press Information Bureau, 20 February 2025.
https://www.pib.gov.in/PressReleseDetailm.aspx?PRID=2104884&lang=2®=48
[7] Ministry of Health and Family Welfare, Government of India, “Update on NP-NCD,” Press Information Bureau, 23 March 2026.
https://www.pib.gov.in/PressReleasePage.aspx?PRID=2243768&lang=1®=3
[8] NCD Risk Factor Collaboration (NCD-RisC). “Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants.” The Lancet. 2024.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01296-5/fulltext
[9] Anjana, R. M., et al. “Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17).” The Lancet Diabetes & Endocrinology. 2023;11(7):474–489.
https://pubmed.ncbi.nlm.nih.gov/37301218/
[10] Anjana, R. M., et al. “Achievement of guideline recommended diabetes treatment targets and health habits in people with self-reported diabetes in India (ICMR-INDIAB-13): a national cross-sectional study.” The Lancet Diabetes & Endocrinology. 2022;10:430–441.
https://pubmed.ncbi.nlm.nih.gov/35461575/
About the Contributor
Annika Saigal is a Research and Editorial Intern at IMPRI. She is currently pursuing a B.A. (Honours) in Political Science, with a minor in Economics, at Lady Shri Ram College for Women, University of Delhi.
Acknowledgement
The author extends her sincere gratitude to the IMPRI team for its guidance and constructive feedback throughout the process.
Reviewed by: Shiva Karthik and Aditya Chavan
Disclaimer
All views expressed in the article belong solely to the author and not necessarily to the organisation.
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