By Dr E.T Arun Thomas – MD (Gen Med), DNB (Gen Med), DM (Nephro), DrNB (Nephro), SCE Nephro RCP (UK), MNAMS, FRCP (London), FIDF
Diabetes mellitus, commonly known as diabetes, is often called a “slow killer” because it quietly damages the body over years without obvious symptoms in the early stages. It is a chronic condition where the body either does not produce enough insulin or cannot use it effectively, leading to high blood sugar levels. Over time, this can cause severe complications like heart disease, kidney failure, blindness, nerve damage, and amputations. What makes diabetes particularly dangerous is that many people live with it undiagnosed until serious problems arise.
India has earned the unfortunate title of the “diabetes capital of the world.” According to a major 2023 study by the Indian Council of Medical Research (ICMR-INDIAB), approximately 101 million Indians are living with diabetes, while another 136 million are in the pre-diabetic stage – a condition where blood sugar is higher than normal but not yet diabetic. The International Diabetes Federation (IDF) Diabetes Atlas estimates around 90 million adults with diabetes in 2024, with prevalence rates hovering between 10-11% nationally. Projections are alarming: the number could rise to over 134 million by 2045 if current trends continue. Globally, one in every seven adults with diabetes is Indian, and the disease affects not just the elderly but increasingly younger, working-age people.
Among Indian states, Kerala stands out as having one of the highest burdens. Studies, including ICMR data and recent surveys, show diabetes prevalence in Kerala ranging from 20-25%, significantly above the national average. For instance, certain reports place Kerala at around 24-25.5%, with Goa slightly higher in some estimates, but Kerala consistently ranks at the top alongside southern coastal states. Tragically, Kerala also recorded the highest proportion of medically certified deaths due to diabetes in 2023 – about 19.1% of such deaths nationwide. This is despite Kerala’s high literacy and advanced healthcare system, highlighting how deeply lifestyle factors have penetrated.
Diabetes Rising Rapidly in India
Clinical trials and large-scale epidemiologic studies worldwide have established clear links between lifestyle and type 2 diabetes, which accounts for over 90% of cases in India (type 1 is less common and usually starts in childhood). Consuming high amounts of added sugars – especially in sugar-sweetened beverages like soft drinks, packaged juices, and energy drinks – leads to weight gain, obesity, high cholesterol (dyslipidaemia), hypertension, and cardiovascular disease. These are direct risk factors for type 2 diabetes.
In India, rapid urbanization, sedentary jobs, and a shift from traditional diets to processed and fast foods have fuelled the crisis. Traditional Indian meals rich in whole grains, vegetables, and legumes are being replaced by refined carbs, fried snacks, and sugary treats. Lack of physical activity compounds this: many spend hours sitting at desks or in front of screens.
Kerala, paradoxically, faces a unique challenge. Known for its coconut-based curries, rice-heavy meals, and love for sweets like payasam, the state has seen a dietary shift towards more refined carbohydrates and oils. High literacy has not translated to widespread health awareness about portion control or exercise. Genetic predisposition among South Indians also plays a role, making people more susceptible at lower body weights than in other populations.
Over 50% of diabetics in India remain undiagnosed, delaying treatment and increasing complication risks. Pre-diabetes affects millions more – estimates suggest 136 million nationally – and without intervention, many progress to full diabetes within years.
Prevention and Control Are Key
The good news is that type 2 diabetes can often be prevented or managed through lifestyle changes. Early screening is crucial: a simple blood test for fasting glucose, HbA1c, or oral glucose tolerance can detect it early.
Key strategies include:
● Healthy diet: Reduce added sugars, refined carbs, and processed foods. Focus on fibre-rich foods like whole grains, vegetables, fruits, lentils, and lean proteins. Limit sugary drinks entirely.
● Regular exercise: At least 150 minutes of moderate activity weekly, like brisk walking, cycling, or yoga.
● Weight management: Even a 5-10% weight loss can significantly lower risk.
● Monitoring and medication: For those diagnosed, regular check-ups, blood sugar monitoring, and prescribed medicines (like metformin or insulin if needed) are essential.
● Quit smoking and limit alcohol.
With these, many can achieve remission in type 2 diabetes or live complication-free. Type 1 diabetes requires lifelong insulin, but good management ensures a normal life.
Fake Medicines and Fraudulent Cure Centres
As diabetes cases surge, unscrupulous elements are exploiting vulnerable patients. Fake medicines and so-called “cure centres” promising quick, permanent fixes are proliferating, especially in states like Kerala with high prevalence.
Recent years have seen multiple raids uncovering spurious anti-diabetic drugs. Counterfeit versions of popular medicines like insulin, metformin, and newer drugs (e.g., semaglutide brands used for diabetes and weight loss) have been seized in large quantities – worth crores in places like Kolkata and Delhi. Fake herbal or Ayurvedic remedies claiming to “cure” diabetes permanently are widely advertised online and in local centres. These often contain no active ingredients, hidden steroids, or harmful substances.
The aftermath of consuming spurious drugs is devastating:
● Ineffective treatment: Fake pills fail to control blood sugar, leading to skyrocketing levels and acute complications like diabetic ketoacidosis or hyperosmolar coma.
● Worsening health: Uncontrolled diabetes accelerates damage to heart, kidneys, eyes, and nerves.
● Toxic side effects: Some fakes contain dangerous chemicals, causing liver/kidney failure, allergies, or poisoning.
● Financial loss and delayed care: Patients waste money and time, often stopping genuine treatment, leading to irreversible damage or death.
● Mortality risk: Substandard drugs contribute to treatment failure and higher death rates.
The World Health Organization and India’s Central Drugs Standard Control Organisation (CDSCO) regularly issue alerts about counterfeit batches. In 2024-2025, fake diabetes and weight-loss drugs from unregulated sources made headlines globally.
The Golden Window: Why the First Five Years of Diabetes Decide the Future
The first five years after a diagnosis of diabetes can be considered the golden years. This is the critical window where the disease can be slowed, and in many with type 2 diabetes, even pushed into remission — preventing long-term damage — if we act decisively with proper diet, weight reduction, regular physical activity, adequate sleep, and stress correction. Early tight control is vital because diabetes carries a “metabolic memory.” Prolonged high blood sugar can trigger epigenetic changes — subtle chemical modifications around our DNA that do not alter the genetic code but influence how genes function. These changes, induced by sustained hyperglycaemia, can persist in the body and continue to promote inflammation and vascular injury even after glucose levels are later controlled. That is why poor control in the early years may leave a lasting imprint on the heart, kidneys, nerves, and eyes. Unfortunately, many newly diagnosed patients panic, deny the condition, or fall prey to unproven miracle cures — and in doing so, they lose their golden years. In diabetes, the first five years often decide the next thirty.
Caution to the public:
● Diabetes has no instant or permanent “cure” through pills or herbs alone. Type 2 can be managed or put into remission with lifestyle and proper medicine, but claims of total cure without evidence are red flags.
● Never buy medicines from unverified online sellers, street vendors, or unregulated centres.
● Consult only qualified doctors – preferably endocrinologists – registered with the Medical Council.
● Purchase from licensed pharmacies; check holograms, batch numbers, and expiry dates.
● Report suspicious products to authorities (e.g., via CDSCO helpline).
● Rely on evidence-based treatments, not testimonials or miracle claims.
A Call to Action
Diabetes is a growing public health crisis in India, hitting Kerala hardest. With over 100 million affected nationally and millions more at risk, urgent action is needed: widespread screening camps, public awareness campaigns on healthy eating and exercise, and stricter regulation of fake drugs.
As individuals, we can fight back by adopting healthier habits today. Families in Kerala and across India must prioritise home-cooked traditional meals in moderation, daily walks, and regular check-ups. Government and communities should promote parks, cycling paths, and nutrition education in schools.
By staying informed and vigilant against frauds, we can control this silent killer. Early detection and proper management save lives – let’s make diabetes manageable, not fatal.
*The author is Professor of Nephrology, Believers Church Medical College Hospital, Thiruvalla, Kerala. He is Co-Founder and Director ‘mySugarClinic’, a mobile app and telemedicine platform strengthening preventive diabetes care through community connection.
