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India’s children are growing up in a world where sweetness has turned from celebration to risk, demanding stronger policies, smarter technology, and fairer care to protect their health.
Image Source: Getty Images
Long before glucose meters and diagnostic strips, Indian physicians were diagnosing diabetes by watching ants. Classical Ayurvedic texts, such as the Charaka Samhita, described a condition called madhumeha (literally “honey urine”), which lured swarms of ants to the patient’s bedside. In essence, these early physicians had identified glycosuria (sugar in urine) millennia before modern glucose meters, recognising excessive thirst and sugary urine as hallmarks of the disease. Such observations show that a historical awareness of diabetes existed in India long before the era of insulin and blood-glucose tests.
Two millennia later, India once again finds itself at the centre of a diabetes story, only this time, it begins in childhood. Evidence shows that metabolic disorders are creeping into younger demographics. For instance, a recent government report titled 'Children in India 2025' revealed that about one-third of Indian children aged 5-9 have elevated triglyceride levels, a red flag for metabolic disease. In some regions, more than one out of every five children is identified as pre-diabetic, and diabetes that is formally diagnosed is gradually appearing in the 10-19 age bracket.
International Diabetes Federation data indicate roughly 301,000 Indian children (0-19 years) are living with T1DM, second only to the United States.
The above changes mirror a bigger change, which is that non-communicable diseases (NCDs) now make up nearly 60 percent of total deaths in India, and diseases that were once considered a concern only for adults, such as obesity, hypertension, and type 2 diabetes, are rising among children. This is a stark backdrop for this year's World Diabetes Day, whose theme, 'Diabetes across life stages,' emphasises that diabetes is not selective as to age. In India’s case, that life stage is starting earlier than ever. What is even more remarkable is that November 14 is also India's National Children's Day, a day dedicated to celebrating the youth as the nation's future. This coincidence underscores the necessity and urgency of protecting children's health from diabetes, so that the next generation will be healthier and more resilient.
Think of metabolism as a compact industrial estate tucked behind the stomach, with the pancreas as a factory. Inside, small teams of engineers — the islet cells — run parallel production lines. One line turns out the hormone insulin, the dispatch manager that moves glucose from the bloodstream into muscle and liver stores. Another ships the hormone glucagon, a recall order that releases fuel when supplies run low. A third hormone, somatostatin, keeps the lines from tripping over one another (it inhibits the release of other hormones/general “off-switch”). And beyond these three, the metabolic hormones also include amylin (co-secreted with insulin), pancreatic polypeptide, and ghrelin from islet ε-cells, while gut incretins (GLP-1, GIP) fine-tune the factory’s output from the outside. When the system hums, inputs — carbohydrates and fats — are taken in, processed, and sent out as steady energy to every neighbourhood of the body.
Diabetes happens when this factory can no longer match demand with delivery. In Type 1, most often first seen in childhood or adolescence, the machinery is attacked by the body’s own security guards; the insulin line seizes, and fuel piles up outside the loading dock (glucose in the blood), while tissues go hungry inside. In Type 2, historically a mid-life problem but now arriving in Indians in their twenties and even teens, the factory still ships insulin, but the city’s customers stop answering; resistance grows, efficiency collapses, and the factory runs hot.
In adolescent boys, for example, obesity prevalence jumped from 1.7 percent to 6.6 percent between 2006 and 2021. This marks a shift from the past, when policies were designed mainly to tackle undernutrition. Now, India faces a dual burden in which the same communities have coexisting stunting and obesity.
Testing the system is how a municipality would audit a factory. A fasting plasma/blood glucose (FBG) check (after at least eight hours without calories) is the opening-shift inspection: if the reading is ≥126 mg/dL*, the plant is already running ‘sweet’; 100-125 mg/dL flags prediabetes. The oral glucose tolerance test (OGTT) then floods the bays with a 75-gram glucose load and times clearance at two hours: ≥200 mg/dL confirms diabetes; 140–199 mg/dL signals impaired glucose tolerance, particularly useful in adolescents and during pregnancy. A random plasma glucose test is the spot inspection; ≥200 mg/dL with classic symptoms is strongly suggestive of diabetes. HbA1c testing (glycated haemoglobin) serves as the quarterly ledger (a 2- to 3-month average exposure to glucose) of how sugary the pipeline has run; ≥6.5 percent for diabetes, 5.7-6.4 percent for prediabetes. But in Indian populations, iron-deficiency anaemia and haemoglobin variants can skew the results, so findings merit confirmation with FBG/OGTT or continuous measures. Ketone testing (preferably blood β-hydroxybutyrate) is the overheating alarm for insulin deficiency and impending diabetic ketoacidosis.
India now has the world’s second-largest diabetes population: about 101 million adults, or 11.4 percent of the adult population, are living with diabetes. Public attention and health programmes overwhelmingly focus on Type 2 diabetes mellitus (T2DM). Meanwhile, Type 1 diabetes (T1DM) remains undercounted. International Diabetes Federation data indicate roughly 301,000 Indian children (0-19 years) are living with T1DM, second only to the United States.
Schools and food policy are on the front line of prevention. The Central Board of Secondary Education (CBSE) has issued circulars aiming to curb sugar and junk food in schools. In 2025, CBSE directed all affiliated schools to set up ‘sugar boards,’ which are notice boards displaying recommended sugar intake, the sugar content of common snacks and drinks, and health risks of excess sugar. Schools were told to organise sugar-awareness workshops and report on enforcement. Efforts have also been made previously: following a 2015 Delhi High Court order, the food safety authority (FSSAI) issued draft guidelines banning the sale of high-fat, salt, and sugar (HFSS) foods in and around schools (within 50 metres). These guidelines were later incorporated into the Food Safety and Standards (Safe Food and Balanced Diets for Children in School) Regulations, 2020, which came into effect in July 2020. In principle, they prohibit the sale and advertisement of HFSS foods within and around school premises and require schools to ensure healthy canteen menus. However, enforcement remains uneven, with state-level implementation varying widely. Front-of-pack labelling on processed foods is another pending prevention strategy. Health advocates have been calling for clear warnings on HFSS foods for a long time, but implementation has lagged due to industry pushback.
India is also undergoing a nutrition transition: while undernutrition remains an issue, childhood overweight and obesity are rapidly rising. According to National Family Health Survey (NFHS) data, the prevalence of overweight among Indian children under 5 doubled from about 1.5 percent in 2006 to 3.4 percent by 2019-21. Among teenagers, obesity rates have tripled or worse. In adolescent boys, for example, obesity prevalence jumped from 1.7 percent to 6.6 percent between 2006 and 2021. This marks a shift from the past, when policies were designed mainly to tackle undernutrition. Now, India faces a dual burden in which the same communities have coexisting stunting and obesity.
A diagnosis of diabetes in childhood can have economic and social implications as well. T1DM management can mean lifelong insulin injections and blood glucose monitoring. Many families, particularly those from economically weaker backgrounds, can find these costs overwhelming. While India's diabetes care market is growing rapidly, most of the more affordable options target adults or T2DM.
Integrating chronic care into the School Health Programme under Ayushman Bharat and the National Education Policy (NEP, 2020) would ensure that health screening and education in schools go beyond just vision tests and deworming to include metabolic health checks and support for conditions like diabetes.
Besides the issue of cost, diabetic children in schools do not have an adequate structured support system. The majority of Indian schools do not have a formal policy for a student's insulin injections, blood sugar checks, or hypoglycaemic episodes. An Indian multicentre survey found fewer than half of children could take pre-meal insulin at school, and only a quarter checked glucose regularly. Some children keep their diabetes a secret from their peers and teachers because they are afraid of being considered sick and treated differently. The National Commission for Protection of Child Rights (NCPCR) has, in fact, issued instructions that schools should facilitate diabetes care, including allowing the kids to carry snacks/glucometers, take medicine, and access support during exams. Paediatric diabetes groups and parents are also pushing for a recognised ‘right to self-care’ in school, meaning every child with a chronic condition like T1DM has the right to monitor and manage their health at school, with necessary accommodations.
Integrating chronic care into the School Health Programme under Ayushman Bharat and the National Education Policy (NEP, 2020) would ensure that health screening and education in schools go beyond just vision tests and deworming to include metabolic health checks and support for conditions like diabetes.
On Children’s Day and World Diabetes Day, the task is clear. The nation must steadily move beyond awareness to precision and equity. Artificial Intelligence, wearables, real-time ketone monitors, digital twins, and other newer and upcoming modalities can personalise care and prevent crises — especially for children with Type 1 — but access would remain unequal unless policy closes the gap. The way forward could be practical: validate low-cost devices, integrate them into Health and Wellness Centres with simple care pathways, link longitudinal data through the Ayushman Bharat Digital Mission with strong privacy guardrails, and fund domestic research and development to bring affordable pumps, sensors, and ketone monitors to market. Precision can help, but equity will decide outcomes. A fair system is the real medicine, one that recognises the child before the diagnosis and the life ahead before the lab value. If we succeed, a sweet childhood will once again mean joy, not glucose.
*mg/dL (milligrams per decilitre, a unit of measurement for concentration)
K. S. Uplabdh Gopal is an Associate Fellow with the Health Initiative at the Observer Research Foundation.
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Dr. K. S. Uplabdh Gopal is an Associate Fellow within the Health Initiative at ORF. His focus lies in researching and advocating for policies that ...
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