New Delhi: India is staring at a diabetes crisis of historic scale. The ICMR-INDIAB study, one of the world’s largest surveys on non-communicable diseases, has found that over 101 million Indians are now living with diabetes and another 136 million are prediabetic. Conducted across all states and union territories, the decade-long research links the epidemic not just to genetics or urbanization, but to India’s carb-heavy diet, dominated by refined rice and wheat. The findings point to an urgent need for dietary reform and early prevention to stem the country’s metabolic health crisis.
ICMR-INDIAB Study
Launched in 2008 by the Indian Council of Medical Research (ICMR) in collaboration with institutions like the Madras Diabetes Research Foundation (MDRF), the ICMR-INDIAB study is a cross-sectional, community-based survey designed to estimate the national prevalence of diabetes and related metabolic NCDs. It covers all 28 states (now expanded to 36 states and union territories in analyses), the National Capital Territory of Delhi, and select union territories, making it nationally representative. The study sampled over 113,043 adults aged 20 years and older, with a balanced representation from urban (33,537) and rural (79,506) areas, ensuring equal gender distribution.
A Snapshot of India’s Metabolic Health Crisis
The ICMR-INDIAB study revealed alarming statistics that highlight India’s escalating NCD (Non-communicable disease) burden. Nationally, the weighted prevalence of diabetes is 11.4%, translating to over 101 million adults affected—far higher than previous estimates. Prediabetes affects 15.3% (136 million people), indicating a massive at-risk population poised for progression to full diabetes. Hypertension stands at 35.5%, generalized obesity at 28.6%, abdominal obesity at 39.5%, and dyslipidemia (e.g., high triglycerides) at a staggering 81.2%.
Southern and northeastern states like Goa (26.4%) and Puducherry (26.3%) show the highest diabetes rates, while rural-urban gaps are narrowing, with urban areas exhibiting higher obesity. The 2025 dietary analysis (ICMR-INDIAB-21) pinpointed dietary patterns as a major culprit: Indians derive 62-70% of calories from carbohydrates—among the highest globally—primarily from low-quality sources like refined white rice (south/east) and wheat flour (north/central). Protein intake is low (9-11%), and fats contribute 14-23%, often saturated. This carb-heavy diet correlates with 14-30% higher risks of diabetes, prediabetes, obesity, and cardiometabolic issues.
Metabolic obesity—high body fat despite normal BMI—is prevalent, affecting even lean individuals due to poor muscle mass and visceral fat accumulation. The study also noted low awareness and poor control: only 7% of self-reported diabetes cases achieve combined ABC targets (A1c <7%, blood pressure <130/80 mmHg, LDL cholesterol <100 mg/dL). These findings underscore the need for preventive measures, as prediabetes offers a “golden window” for intervention to avert progression.
How to Keep Away from Diabetes ?
Preventing diabetes, especially type 2, involves addressing modifiable risk factors like diet, physical activity, and lifestyle habits, as highlighted by the ICMR-INDIAB study. The rapid transition from prediabetes to diabetes in India is faster than in Western populations.
- Maintain a Healthy Weight: Aim for a BMI of 18.5-23 kg/m² (Asian-specific cutoff) and waist circumference <90 cm for men, <80 cm for women to reduce abdominal obesity. Even 5-10% weight loss can lower diabetes risk by 58% in prediabetic individuals.
- Increase Physical Activity: Engage in at least 150 minutes of moderate aerobic exercise weekly (e.g., brisk walking, cycling) plus strength training twice a week. The study links sedentary lifestyles to higher NCD risks.
- Regular Screening: Monitor blood glucose levels annually if at risk (family history, overweight, age >45). Early detection of prediabetes allows reversal through lifestyle changes.
- Quit Smoking and Limit Alcohol: Tobacco exacerbates insulin resistance; limit alcohol to <14 units/week for men, <7 for women.
- Manage Stress and Sleep: Chronic stress raises cortisol, impairing glucose control. Aim for 7-9 hours of sleep nightly.
- Dietary Overhaul: The cornerstone of prevention, as per the study, is shifting from high-carb to balanced diets. Optimization models from ICMR-INDIAB suggest reducing carbs to 50-55% of energy intake while increasing proteins to 15-20% for remission and prevention.
Following the “ABCD” mantra—Awareness, Balanced diet, Check-ups, Discipline—can prevent complications.
What to Eat and What Not to Eat for Diabetes Prevention
Based on ICMR-INDIAB insights and ICMR guidelines, dietary choices should prioritize nutrient density over calorie density to combat the carb-protein imbalance. High-carb diets from refined grains increase metabolic risks by 15-30%, while substituting with proteins reduces them.
What to Eat
- Vegetables and Fruits: Non-starchy veggies (e.g., spinach, broccoli, cauliflower) and low-glycemic fruits (e.g., apples, berries, guava) for fiber and micronutrients. Aim for half your plate as veggies.
- Proteins: Plant-based (pulses, lentils, soy), dairy (low-fat milk, yogurt, paneer), and lean animal sources (fish, chicken, eggs). Increase to 15-20% of calories.
- Whole Grains: Millets (ragi, jowar), brown rice, whole wheat over refined varieties for better glycemic control.
- Healthy Fats: Nuts (almonds, walnuts), seeds (chia, flax), avocados, and oils like mustard or olive in moderation (20-30% of energy, with <7% saturated).
- Legumes and Dairy: Beans, chickpeas, and fermented dairy for protein and gut health.
What Not to Eat (or Limit)
- Refined Carbs: White rice, maida-based roti/paratha, sugary cereals—major contributors to high carb intake (limit to <50% energy).
- Sugary Foods/Drinks: Sweets, sodas, fruit juices—added sugars spike blood glucose.
- Processed Foods: Chips, biscuits, fast food high in trans fats and sodium.
- Red and Processed Meats: Limit due to saturated fats; prefer over carbs only if needed, but plant/dairy proteins are better.
- Fried Items: Deep-fried snacks increase calorie density without nutrition.
Portion control is key: Use ICMR’s “My Plate for the Day” model—half veggies/fruits, quarter grains, quarter proteins, plus dairy.
ICMR Food Recommendations
The ICMR-INDIAB study’s dietary arm analyzed over 18,000 participants’ intakes, revealing that carbs constitute 62% of energy (higher in rural areas at 65%), proteins 10%, and fats 21-26%. This imbalance stems from traditional staples: rice in south/east (providing 70-80% carbs), wheat in north/central. Low-quality carbs (refined, low-fiber) lead to rapid glucose spikes, insulin resistance, and fat storage, exacerbating diabetes risk by 14-30%.
Optimization models recommend isocaloric substitutions: Replace 5-10% carbs with proteins to reduce risks by 10-20%. Plant/dairy proteins (e.g., lentils, milk) show stronger protective effects than animal ones, without increasing fat intake. Saturated fats (from ghee, coconut oil) should be <7% to avoid dyslipidemia.
ICMR’s 2024 Dietary Guidelines for Indians align with this: Consume from 8 food groups daily—cereals/millets (limited refined), pulses, veggies (≥300g), fruits (≥100g), nuts/seeds, dairy (300ml low-fat), oils/fats (27g), and eggs/meat/fish optionally. For diabetes prevention, carbs 55-60% from complex sources; proteins 10-15% (vegetable-heavy); fats 20-25% (MUFA/PUFA dominant).
Sample meal: Breakfast—oats with milk and nuts;
Lunch—millets roti, dal, veggies, yogurt; Dinner—grilled fish, salad, whole grains.
Younger adults need more proteins for muscle; women post-menopause focus on calcium-rich dairy. Rural diets, higher in carbs, benefit most from adding affordable proteins like pulses.
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