More than 100 million people in India are now diabetic. As per a recent study published in The Lancet Diabetes and Endocrinology, a staggering 11.4% of the country’s population is living with the disease and 136 million people or 15.3% of the people with prediabetes. However, India’s diabetes burden is not evenly spread across the country. Southern states report the highest prevalence of diagnosed diabetes, while many northern and eastern states are witnessing a sharp rise in prediabetes.
The same study notes that diabetes prevalence is lower in Uttar Pradesh, Madhya Pradesh, and Bihar compared to Southern states like Kerala where high cases of diabetes are reported. At the same time several northern and eastern states are now flagging alarmingly high levels of prediabetes. Dr RM Anjana, managing director at Dr Mohan’s Diabetes Specialities Centre, told The Indian Express that more than 60% of people with pre-diabetes end up converting to diabetes in the next five years.
Why diabetes is more prevalent in South India
“Southern India shows higher diabetes prevalence because populations are more urban, sedentary, and older, allowing prediabetes to progress faster,” explains Dr Amrita Ghosh, diabetologist at Fortis C-Doc Hospital for Diabetes and Allied Disorders. Better screening and health awareness in the region also mean more people are diagnosed rather than remaining hidden cases.
“In contrast, many northern and eastern states are seeing a surge in prediabetes due to rapid lifestyle changes but lower detection. These regions are essentially at an earlier stage of the same epidemic. Better screening in the south also means more cases are diagnosed rather than hidden,” Dr Ghosh adds.
While regional trends are real, some experts argue that the divide isn’t strictly north versus south. Socioeconomic status plays a major role.
“As per national surveys, diabetes prevalence is higher in southern states, but prediabetes is more closely linked to socioeconomic classes than geography,” says Dr Girish Parmar, Director of Endocrinology and Diabetology at Nanavati Max Super Speciality Hospital, Mumbai. Middle and lower-income groups are more likely to remain in the prediabetic stage due to limited awareness, delayed diagnosis, and poor access to healthcare.
According to Dr Mahesh D M, Senior Consultant – Endocrinology, Aster CMI Hospital, Bengaluru, diabetes has simply been present longer in the south. “Diets rich in polished rice, fried foods and coconut-based dishes, along with low physical activity and sedentary jobs, have driven the disease over years. In contrast, northern and eastern states are undergoing rapid lifestyle change, pushing many people into prediabetes without timely diagnosis.”
That means large sections of India may be living with impaired glucose tolerance often without knowing it.
Is white rice really to blame?
White rice is often considered the biggest dietary culprit when it comes to discussing diabetes in India. However, doctors say focussing on a single food misses the bigger picture.
“White polished rice plays a role due to its high glycaemic index, but it’s not the only culprit,” says Dr Ghosh. The real issue, she explains, is a diet dominated by refined carbohydrates, sugars, and low fibre combined with large portions and frequent snacking.
Dr Parmar agrees. Over 60–70% of daily energy intake in Indians comes from carbohydrates, often refined ones. “It’s not rice alone, but a high-carb, low-fibre, high-sugar dietary pattern that drives insulin resistance,” he says.
Southern states, where polished rice forms the bulk of daily meals, show a clearer link between high carbohydrate intake, rising BMI, and diabetes. Meanwhile, in northern and eastern India, increased consumption of refined wheat, sugar, packaged foods, and sugary drinks is bringing blood sugar levels up, often stopping at the prediabetes stage for now.
According to Dr Mahesh D M, eating rice or roti without adequate protein, fibre or vegetables leads to repeated glucose spikes. “The real issue is a high-carb, low-fibre, low-protein diet combined with weight gain and reduced activity.”
What dietary changes can lower diabetes risk?
Small but consistent dietary changes can significantly reduce diabetes risk and delay onset.
“Improving meal balance rather than eliminating foods is key,” says Dr Amrita Ghosh. “Adding protein from dals, legumes, eggs, dairy, fish or lean meat helps blunt glucose spikes and improves satiety.”
Dr Parmar recommends focusing on low-glycaemic, high-fibre foods such as pulses, whole grains, vegetables and fruits, while limiting sugar, salt, saturated fats and processed foods.
Dr Mahesh D M adds that reducing portion sizes of white rice and maida-based foods, increasing vegetables and protein, switching to millets or whole grains, and maintaining regular meal timings can significantly improve metabolic health.
Are we having enough protein?
One of the most consistent gaps across India is protein intake.
“Most Indians consume far less protein than required for their body weight,” says Dr Ghosh. Meals are heavily carbohydrate-based, with dal often treated as the only protein source. Breakfasts are especially protein-poor, worsening post-meal glucose spikes.
Dr Parmar adds that excessive dependence on cereals leaves little room for fibre and protein-rich foods. “A balanced diet that reduces refined carbohydrates and increases protein and fibre significantly lowers insulin resistance risk.”
Experts recommend spreading protein evenly across meals and diversifying sources — pulses, dairy, eggs, soy, fish, or lean meats rather than concentrating it in a single meal.
The silent wave of prediabetes
Prediabetes is spreading silently but surely and this is one time bomb that can explode anytime, adding to people’s health woes.
“Prediabetes is largely silent, which is why India is sitting on a potential diabetes explosion,” warns Dr Ghosh. Without lifestyle changes, a significant proportion of people with prediabetes will convert to diabetes within a decade.
Dr Parmar notes that impaired glucose tolerance is common even in rural areas, dispelling the myth that diabetes is only an urban disease. “The longer individuals remain undiagnosed, the more likely they are to become diabetic — creating a silent wave.”
“India is already on the verge of becoming the diabetes capital of the world. Major risk factor being the existing Prediabetic population, which is at times reported to be around 5–6% in some regions and much higher in poorer socio-income groups. This is also common in rural regions if one may think diabetes as an urban disease,” says Dr. Girish Parmar, Director – Endocrinology & Diabetology, Nanavati Max Super Speciality Hospital, Mumbai.
Sitting may be as dangerous as sugar
Diet isn’t acting alone. Sedentary behaviour is a powerful but underestimated driver of diabetes risk.
“Prolonged sitting reduces muscle glucose uptake and worsens insulin resistance,” Dr Ghosh explains. Even regular workouts can’t fully offset all-day inactivity. Short walks after meals, movement breaks, and daily strength training help muscles absorb glucose more effectively.
Experts say modern urban life which includes long commutes, desk jobs, screen time has quietly accelerated metabolic disease across age groups.
Can diet alone reverse prediabetes?
“In early-stage prediabetes, diet and physical activity alone can normalise blood sugar,” says Dr Amrita Ghosh. “Even a 5–10% weight loss improves insulin sensitivity.”
Dr Parmar emphasises early detection. “The sooner lifestyle intervention begins, the better the chances of avoiding diabetes.”
According to Dr Narendra BS, people with mild insulin resistance can reverse abnormal sugar levels through reduced refined carbs, increased fibre, lean protein and sustained lifestyle changes before medication becomes necessary.
Lifestyle habits that can reverse diabetes risk
Experts agree that consistency matters more than extremes.
Key habits include:
Regular walking and strength training
Balanced meals with protein, fibre and healthy fats
Adequate sleep
Stress management
Avoiding sugary drinks and late-night eating
Regular screening for high-risk individuals
“Lifestyle change remains the most powerful tool against diabetes,” says Dr Amrita Ghosh.
Disclaimer: The information in this article is for educational and informational purposes only and is not intended as medical advice. While the author has incorporated expert medical guidance while producing the story and ensured full authentic information is provided to the reader, you should always seek the advice of a qualified healthcare provider regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.