5 min readJun 29, 2026 10:00 AM IST
First published on: Jun 29, 2026 at 10:00 AM IST
When I began my journey in diabetes care more than four decades ago, India was already witnessing a silent epidemic. Today, that epidemic has grown into one of the country’s greatest public health challenges. India is home to more than 100 million people with diabetes and another 136 million at high risk of developing the condition. Yet the challenge is not unique to India. Across low- and middle-income countries, diabetes is rising rapidly, stretching healthcare systems that are often under-resourced and overburdened.
The question I have grappled with throughout my career is simple: How do we provide quality diabetes care to millions of people when specialists, infrastructure and financial resources are limited?
The answer, I believe, lies not in replicating models from wealthy countries but in developing solutions that are locally relevant, affordable and scalable.
One of the earliest lessons we learnt was that diabetes in South Asians differs in important ways from diabetes in many Western populations. Indians tend to develop diabetes at younger ages and at lower body weights. Many patients present late, often after complications have already set in. This means prevention, early diagnosis and regular monitoring become even more critical.
Yet conventional healthcare models are poorly suited to this reality. Asking patients to visit multiple clinics for eye examinations, kidney assessments, foot care, nutrition counselling and laboratory investigations is impractical, especially for those travelling long distances or paying out of pocket.
This realisation led us to develop an integrated model of diabetes care in which all essential services are available under one roof. The objective was simple: reduce the burden on patients while ensuring comprehensive evaluation and treatment during a single visit. Such integrated care not only improves convenience but also increases the likelihood that complications are detected early.
However, infrastructure alone cannot solve the problem. A country the size of India does not have enough endocrinologists or diabetes specialists to care for every patient. Capacity building therefore became central to our work. We invested heavily in training physicians, diabetes educators, nurses, podiatrists and other healthcare workers. Task-sharing and task-shifting are no longer optional strategies; they are essential if diabetes care is to reach underserved populations.
Technology has emerged as another powerful equaliser. Digital health tools, telemedicine platforms and mobile applications can bridge the gap between patients and healthcare providers. They allow individuals to access information, monitor their condition, receive reminders, communicate with healthcare teams and maintain continuity of care between clinic visits. For chronic diseases such as diabetes, where long-term engagement is critical, these tools can make a measurable difference.
Perhaps one of the most rewarding experiences has been taking diabetes care beyond urban centres. Through mobile units equipped with diagnostic facilities, we have been able to screen for diabetes and its complications in remote villages where specialist services are unavailable. More recently, home-based care models have further expanded access, particularly for elderly patients and those with mobility limitations.
The COVID-19 pandemic reinforced the importance of these innovations. During lockdowns, teleconsultations and digital monitoring enabled patients to remain connected to healthcare providers even when physical visits were impossible. What began as an emergency response has now become a permanent component of diabetes care.
Research has also played a crucial role. For too long, many clinical guidelines were based largely on data generated in high-income countries. While such evidence is valuable, it does not always reflect the realities of populations in Asia, Africa or Latin America. Locally generated research helps us understand disease patterns, risk factors and treatment responses within our own communities. It enables us to design interventions that are both scientifically sound and contextually relevant.
There is another lesson that deserves emphasis. Healthcare cannot succeed if it excludes those who cannot afford it. In countries where a significant proportion of healthcare expenditure comes directly from patients’ pockets, affordability remains a major barrier. Sustainable solutions must therefore incorporate mechanisms that expand access for economically disadvantaged groups.
As the global burden of diabetes continues to rise, low- and middle-income countries can no longer rely solely on imported healthcare models. They must innovate, adapt and build systems that reflect local realities. India’s experience demonstrates that even in resource-constrained settings, meaningful progress is possible through integrated care, workforce development, technology, research and community engagement.
The challenges remain enormous. But if there is one lesson I have learnt over four decades, it is that solutions do not always emerge from abundance. Sometimes they emerge from necessity. And those solutions, born in countries like India, may hold valuable lessons for the rest of the world.
(The author is Chairman, Dr Mohan’s Diabetes Specialities Centre, Chennai)
India's diabetes epidemic has driven innovations in integrated care, workforce training and digital health that can help low- and middle-income countries improve diabetes outcomes at scale, writes Dr V Mohan. (File Photo) 
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