Why Lancet study on diabetes is a red flag: A quarter of diabetics globally are Indians

Report released on World Diabetes Day used fasting glucose level and HbA1c as parameters

The prevalence of diabetes in India in 2022 was 14.4 per cent (69 million) among women and 12.2 per cent for men (62 million) --- 131 million in total --- in the ICMR-INDIAB study. (File Photo)

A quarter of adults living with diabetes globally are in India (212 million of the 828 million) according to a Lancet report, published on World Diabetes Day. Based on data till 2022, the other nations with the most diabetics are China (148 million), US (42 million), Pakistan (36 million), Indonesia (25 million) and Brazil (22 million).

The study, conducted by the NCD Risk Factor Collaboration (NCD-RisC) in collaboration with WHO, is the first global analysis of trends in both diabetes rates and treatment. Researchers used data from over 140 million 18-plus people available in more than 1,000 studies. They used the two most commonly used diagnostic criteria — a fasting plasma glucose (FPG) level of 7.0 mmol/L or 126 mg/dL and HbA1c (average blood sugar count of three months) count of 6.5 percent or higher.

Why the India figures seem to be higher

Dr R M Anjana, president of the Madras Diabetes Research Foundation and one of the authors of the Lancet study, points out how using the HbA1c blood test and fasting glucose rate as calculation benchmarks could have increased the prevalence numbers. “We had chosen the gold standard Oral Glucose Tolerance Test (OGTT), which can even indicate prediabetes, in our earlier ICMR-INDIAB paper last year. In this paper, with HbA1c and fasting glucose as deciders, the number of people with diabetes went up. It is also important to note that the HbA1c can be influenced by several factors like anaemia, blood disorders and certain drugs. Hence it is not an entirely reliable marker for diagnosis of diabetes,” she explains. Top diabetologist Dr C S Yajnik says his paper in 2012 had highlighted how anaemia and iron deficiency elevated HbA1c levels, leading to potential misdiagnosis of diabetes/pre-diabetes in people who have normal glucose tolerance but are anaemic. “Hence glucose measurements are preferred in countries where anaemia and iron deficiency are prevalent,” he says.

Accordingly, without the inclusion of HbA1c, the prevalence of diabetes in India in 2022 was 14.4 per cent (69 million) among women and 12.2 per cent for men (62 million) — 131 million in total — in the ICMR-INDIAB study.

What are risk factors?

Obesity and poor diets are risk factors globally. “India needs ambitious policies in lower-income regions on restricting unhealthy foods, making healthy foods affordable and even free in school meals, promoting safe places for walking and exercising, including free entrance to public parks and fitness centres,” says Dr Anjana.

Lack of treatment

Worldwide three out of five 30-plus people (59 per cent or 445 million) did not receive medication for diabetes in 2022, three-and-a-half times the number in 1990 (129 million). In 2022, almost 64 million men and 69 million women with untreated diabetes lived in India. “This is especially concerning as people with diabetes tend to be younger in low-income countries and, in the absence of effective treatment, are at risk of life-long complications – including amputation, heart disease, kidney damage or vision loss – or in some cases, premature death,” says senior author Professor Majid Ezzati of Imperial College London.

Anuradha Mascarenhas

Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Awards and Recognition Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions. ... Read More