Despite the well-established efficacy of injectable insulin in achieving and maintaining optimal glycaemic control, its acceptance among people living with diabetes (PWD) in India remains disproportionately low. Delayed or inadequate insulin therapy often results in prolonged poor glycaemic control, increasing the risk of diabetes-related complications and contributing to a higher healthcare burden. This review aims to examine key barriers to the initiation and intensification of injectable insulin therapy in India and to explore strategies to address these challenges. A narrative review of the existing literature was conducted to identify barriers influencing the use of injectable insulin. Barriers were categorized into patient-related, healthcare provider (HCP)-related, and healthcare system–related factors. Multiple interrelated barriers were identified. Patient-related barriers include fear of injections, social stigma, and misconceptions regarding insulin therapy. HCP-related barriers involve clinical inertia and limited time for patient education, which delay insulin initiation and intensification. System-level barriers include challenges related to access, affordability, and resource constraints within the healthcare infrastructure. Emerging strategies to overcome these obstacles include structured patient education, focused HCP training, healthcare policy interventions, and innovations such as non-invasive insulin delivery systems. Overcoming barriers to injectable insulin therapy requires a comprehensive, multi-stakeholder approach. Integration of educational, clinical, policy, and technological strategies may improve insulin acceptance and optimize diabetes management outcomes in India.
Type 2 diabetes mellitus (T2D) is a growing global and Indian health challenge. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), increasingly used in India, are linked to higher genitourinary infection (UTI/GTI) rates in people with T2D worldwide, yet real-world evidence in India remains limited. The impact of combining SGLT2i with Dipeptidyl peptidase-4 inhibitors (DPP4i) on infection risk also requires investigation in this setting. This multicenter, cross-sectional, observational study enrolled adults with T2D across India from June 15 to September 30, 2023. Data on UTI/GTI incidence, antidiabetic medications, demographics, and comorbidities were collected. Logistic regression and propensity score matching evaluated associations between SGLT2i, DPP4i, their combination, and UTI/GTI risk. Of 15,611 T2D patients across 42 sites, the mean age was 55.7 years (SD 12.1) and mean BMI 26.7 kg/m2 (SD 4.8). Urogenital infection incidence is 11.3
[This corrects the article DOI: 10.1016/j.obpill.2026.100296.].
India has one of the world’s largest burdens of prediabetes and type 2 diabetes mellitus (T2DM), characterized by early age of onset, high rates of undiagnosed disease, and increased cardiometabolic risk. Early identification and intervention are essential to reduce long-term complications. This position statement integrates national epidemiological data, international evidence, and expert clinical perspectives to provide India-specific recommendations for screening, diagnosis, risk stratification, and management of prediabetes and T2DM. Universal screening from 30 years of age and targeted screening for high-risk individuals are recommended using fasting plasma glucose, OGTT, HbA1c, and validated risk scores such as the Indian Diabetes Risk Score. Prediabetes should be managed with phenotype-based risk stratification and early cardiovascular risk assessment. Lifestyle modification remains the cornerstone of care, including weight reduction, dietary optimization, physical activity, and community-based interventions. Metformin is recommended for high-risk individuals, while SGLT2 inhibitors and GLP-1 receptor agonists may be considered in selected populations. For established T2DM, metformin remains first-line therapy with early combination treatment and individualized pharmacotherapy. Strengthening primary care, improving awareness, expanding access to preventive services, and integrating digital health tools are critical to reducing the growing burden of diabetes and its complications in India.
Rapid dietary transitions in India have been associated with an alarming rise in cardiometabolic diseases. Using data from the national Indian Council of Medical Research-India Diabetes survey (18,090 adults), we examined India's dietary profile and the effect of isocaloric substitution of carbohydrates with other macronutrients on metabolic risk. Indian diets are characterized by high intakes of low-quality carbohydrates (white rice, milled whole grains and added sugar), high levels of saturated fat and low intakes of protein. Compared to those with the least carbohydrate intakes, those with the highest intakes had higher risk of newly diagnosed type 2 diabetes (T2D; odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.14,1.47), prediabetes (OR = 1.20, 95% CI = 1.06,1.33), generalized obesity (OR = 1.22, 95% CI = 1.07,1.37) and abdominal obesity (OR = 1.15, 95% CI = 1.01, 1.30). Replacing refined cereals with whole wheat or millet flour without decreasing overall carbohydrate quantity was not associated with lower risk for T2D (OR = 0.94, 95% CI = 0.57, 1.56) or abdominal obesity (OR = 1.08, 95% CI = 0.66, 1.76). Modeled isocaloric substitution of carbohydrates for plant, dairy, egg or fish protein was associated with lower likelihood of T2D (ranging from OR = 0.89, 95% CI = 0.83, 0.95-for dairy to OR = 0.91, 95% CI = 0.82, 0.99-egg) and prediabetes (ranging from OR = 0.82, 95% CI = 0.72, 0.92-for dairy to OR = 0.94, 95% CI = 0.89, 0.99-for fish). Public health strategies that reduce overall carbohydrates and saturated fat while increasing intake of plant and dairy proteins could mitigate the risk of metabolic diseases in India.
