India@100: diabetes care projection through evidence, partnerships, and professional leadership in next 21 years

Background: India faces one of the largest global diabetes burdens, with an estimated 89.8 million adults affected in 2024, over four in ten of whom are undiagnosed.1 The ICMR–INDIAB study has documented wide regional variation,2 while NFHS-5 underscores persistent gender and access inequities.3 Despite this, India has generated high-quality prevention evidence (IDPP, Kerala DPP)9,10 and scaled national health programmes such as NPCDCS and Ayushman Bharat.4 Methods: Narrative synthesis of epidemiological data (IDF 2024, INDIAB), Indian and global prevention trials (IDPP, DPP, Da Qing, Finnish DPS), and government programme reports (NPCDCS, ABDM). Results: Four anchors are identified for diabetes transformation: (1) equity-first access; (2) life-course prevention; (3) digital and AI integration; (4) clinician–public health convergence. Professional societies (RSSDI, ESI) are highlighted as catalysts for training, registries, quality benchmarks, and policy partnerships. Conclusion: By 2047, success must be evidence-based and measurable: ≥80% awareness of diabetes, ≥60% achieving HbA1c <7%, halved rates of amputations and blindness, delayed dialysis onset by ≥5 years, and elimination of gender and rural inequities. These targets align with Indian data and global precedents.2,4,6,13–15 Diabetes in India should evolve from a symbol of systemic gaps to one of resilience and reform.