India's surging epidemic: 1 in 5 teens diabetic or prediabetic

India has brought childhood diabetes care into the public health system under RBSK 2.0. The move comes as prediabetes and type 2 diabetes rise sharply among adolescents, sharpening the focus on early detection, treatment and prevention.

In Short

• Sedentary routines, screens and processed foods are reshaping childhood health risks
• Obesity is rising sharply, pushing type 2 diabetes into earlier years
• Sudden type 1 diabetes makes warning signs more useful than mass screening

A quiet but deeply worrying health crisis is unfolding among India’s youngest citizens. Recent estimates suggest that among adolescents aged 10–19 years, 12.3 percent are prediabetic while 8.4 percent already have type 2 diabetes.

Diabetes is a chronic metabolic condition where the body cannot regulate blood sugar (glucose) due to lack of insulin or resistance to it. Prediabetes is a state that not only precedes diabetes but also raises the risk of heart attacks and strokes.

The alarming numbers mean nearly one in five teenagers is on the diabetes spectrum-numbers that would have been unthinkable just a generation ago.

This surge has pushed the government to act. The decision by the administration led by Narendra Modi to integrate childhood diabetes care – covering diagnosis and lifelong treatment – into the public health system marks a significant shift.

Under the revised Rashtriya Bal Swasthya Karyakram (RBSK 2.0), India now has a standardized national framework to manage childhood diabetes for the first time.

The urgency is hard to overstate, especially since the country is also the world’s diabetes capital with 10. 1 crore adults with diabetes and another 13.6 crore have prediabetes.

India has one of the largest child populations in the world, with over 430 million or 43 crore individuals under 18. Within this vast demographic, the rising burden of diabetes signals not just a medical issue, but a looming public health and economic challenge.

CRISIS FUELLED BY MODERN LIVING

At the heart of the problem lies a dramatic shift in how children live, eat, and grow. Sedentary routines, increased screen time, processed foods, and reduced physical activity are reshaping childhood itself.

These changes are closely tied to a parallel rise in obesity – one of the strongest predictors of type 2 diabetes.

A recent report by the World Obesity Federation highlighted that in 2025, nearly 14.9 million (1.49 crore) Indian children aged 5–9 and over 26.4 million (2.64 crore) adolescents were overweight or obese. India now ranks among the countries with the highest number of children carrying excess weight.

This matters because type 2 diabetes, once considered an adult disease, is now appearing earlier. As veteran diabetologist and scientist Dr V Mohan has observed in clinical practice, the same triggers seen in adults – poor diet, lack of exercise, and stress – are increasingly affecting children.

Cases that were once seen in people in their 40s are now being diagnosed in teenagers, and even in children as young as seven or eight, he said.

The numbers tell a stark story: one in ten school-age children is already prediabetic, showing elevated blood sugar levels that could progress to full diabetes without intervention.

NOT ONE DISEASE, BUT MANY

Childhood diabetes is not a single condition but a spectrum of disorders, each with distinct causes and treatments.

At the earliest stage of life lies neonatal diabetes, a rare condition that appears within the first six months.

It is typically caused by genetic mutations that impair insulin production. These infants present with severe symptoms such as high blood sugar and dehydration. While insulin is often required initially, they can also be managed with oral medication in many cases.

Research efforts, including a national registry being developed by the Indian Council of Medical Research (ICMR) in collaboration with Dr Mohan’s Madras Diabetes Research Foundation (MDRF) aim to better understand and manage this rare form.

More common is type 1 diabetes, usually diagnosed in children and adolescents.

This is an autoimmune condition in which the body attacks insulin-producing cells. It develops rapidly and can become life-threatening within days if untreated.

Children with type 1 diabetes require lifelong insulin therapy, often multiple injections daily and India is estimated to have 3 lakh such individuals.

The condition develops suddenly, meaning a child who tests negative one week could develop symptoms the next. Instead, awareness of warning signs becomes crucial.

Doctors often refer to the “four Ts”-toilet (frequent urination), thirst, tiredness, and thinness – as key symptoms that should prompt immediate testing.

Then there is type 2 diabetes, the fastest-growing category in children. Unlike type 1, it develops gradually and is strongly linked to obesity, family history, and lifestyle.

It is increasingly seen around puberty and is often accompanied by signs such as weight gain, skin changes like darkened patches around the neck, and in girls, hormonal issues such as irregular periods.

THE BURDEN OF EARLY ONSET

One of the most concerning aspects of childhood diabetes is not just its rising prevalence, but its long-term consequences. When diabetes begins early, the body is exposed to high blood sugar for a longer duration, increasing the risk of complications.

Dr Anuradha Khadilkar, a Pune-based paediatric endocrinologist who has extensively researched childhood diabetes, underscores this point clearly: “When a middle-aged person develops diabetes, it's highly likely that they have one or more diabetes-related complications a few years down the line-so a kid with diabetes also tends to have complications and since they live with the disease longer, the quality of life can deteriorate to a great extent.”

This means that children diagnosed today may face decades of health challenges, including heart disease, kidney damage, nerve problems, and vision loss. The emotional and psychological toll is equally significant, affecting schooling, social life, and overall well-being.

TREATMENT: PROGRESS AND GAPS

Treatment strategies vary depending on the type of diabetes. Neonatal diabetes requires careful diagnosis and may shift from insulin to oral drugs based on genetic findings.

Type 1 diabetes demands lifelong insulin therapy, along with regular blood glucose monitoring. The government’s move to provide free insulin, testing strips, and glucometers is expected to significantly ease the burden on families.

Type 2 diabetes, on the other hand, is often manageable through lifestyle changes – healthy eating, increased physical activity, and weight reduction – along with oral medications when needed.

These medications are the same as the ones used in adults – but not all diabetes therapies are proven to be safe for use in those under 18, and they include the blockbuster GLP-1-based therapies such as tirzepatide (Mounjaro) and semaglutide.

Also, adherence remains a challenge, especially among adolescents.

Experts caution that while the new national framework is a welcome step, screening strategies need to be targeted.

As Dr Mohan explains, in essence, screening millions of children to detect a handful of cases is neither efficient nor practical. Instead, a risk-based approach – focusing on children with obesity, family history, or symptoms – is likely to yield better results.

BEYOND TREATMENT: PREVENTION AND AWARENESS

The real opportunity lies in prevention. If the current trends continue, India could face an unprecedented burden of chronic disease beginning in childhood. But this trajectory is not inevitable.

Encouraging healthier diets, promoting physical activity in schools, reducing screen time, and increasing awareness among parents and teachers can make a significant difference.

As experts point out, even the policy push can have ripple effects – sparking broader conversations about nutrition and exercise from an early age.

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