India faces the second-highest economic burden due to diabetes, estimated at USD 16.5 trillion, a new global study has found, second only to the United States at USD 11.4 trillion, and ahead of China at USD 11 trillion—with informal care costs contributing significantly to the burden.
The estimate captures the cumulative economic shock of a chronic disease that reduces workforce participation, drains household incomes, and shifts long-term caregiving responsibilities onto families, often forcing caregivers to step away from paid work.
The finding comes as diabetes continues to surge worldwide. Over the past three decades, the disease has become one of the top ten contributors to the global health burden, driven by ageing populations, urban lifestyles, obesity, and environmental risks.
In 2021, an estimated 53.7 crore adults were living with diabetes globally, most of them in low- and middle-income countries, and nearly half were unaware of their condition. With numbers projected to rise sharply in the coming decades, the findings underscore why diabetes is no longer just a public health issue but a challenge that demands coordinated action across healthcare, economic planning, and prevention strategies.
What the study says
The study, published in ‘Nature Medicine’, was conducted by researchers from the International Institute for Applied Systems Analysis and the Vienna University of Economics and Business in Austria. The team calculated the economic impact of diabetes across 204 countries between 2020 and 2050, capturing both direct and indirect costs associated with the disease.
Their findings show that global diabetes-related costs amount to approximately USD 10 trillion when informal caregiving is excluded, roughly 0.2 per cent of the world’s annual gross domestic product (GDP).
However, when informal care provided by family members is factored in, the burden rises dramatically. "When considering the substantial labor loss due to informal care for diabetes mellitus, the total economic burden amounts to INT$78.8 trillion, which is equivalent to an annual tax of 1.72% on global GDP and more than six times the cost without considering informal care,"(sic.) it says, highlighting how significantly informal care costs add to the economic burden.
“Caregivers often drop out of the labour market, at least partially, which creates additional economic costs,” said Klaus Prettner, professor of macroeconomics and digitalisation at the Vienna University of Economics and Business and one of the study’s authors.
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"The United States faces the largest economic burden of diabetes mellitus at INT$ 2.5 trillion, followed by India at INT$ 1.6 trillion and China at INT$ 1.0 trillion. When considering informal care loss, the largest economic burdens are INT$ 16.5 trillion in the United States, INT$ 11.4 trillion in India and INT$ 11.0 trillion in China," the authors wrote. An international dollar (INT$) is a statistical unit used to compare economic metrics across countries, with the same purchasing power as a U.S. dollar.
The reasons behind these costs differ across countries. For India and China, the high economic burden is primarily driven by the sheer size of the affected population, while in the United States, high treatment costs and the diversion of physical capital play a larger role.
The study highlights a sharp distinction between high- and low-income countries in how the burden is distributed. In high-income countries, approximately 40.5 per cent of the total economic burden comes from reduced physical capital accumulation due to savings being diverted to finance treatment. This share drops to 34.6 per cent in upper-middle-income countries, 15.5 per cent in low-income countries, and 14.0 per cent in lower-middle-income countries.
Regional differences are also stark. Treatment costs account for 43.6 per cent of the total diabetes burden in North America, compared to just 14.2 per cent in South Asia. “This is a stark illustration of how medical treatment regimes for chronic diseases such as diabetes are accessible to high income countries only,” said co-author Michael Kuhn, acting economic frontiers research group leader at the International Institute for Applied Systems Analysis. The researchers noted that the economic impact of diabetes exceeds that of other major diseases, such as Alzheimer’s disease or cancer, making it one of the most financially devastating health conditions globally.
Suggestions and limitations of the study
The authors stress that reducing the burden of diabetes is critical for both public health and economic stability. “Our findings suggest that strengthening public health interventions to reduce the burden of diabetes is essential to protect global health and economic well-being,” the study notes. It points to the World Health Organization’s Global Diabetes Compact as a key initiative aimed at improving diabetes prevention and care, particularly in low- and middle-income countries.
The study outlines several priority interventions.
Strengthening lifestyle measures is central, with evidence showing that nearly 90 per cent of type 2 diabetes cases could be prevented through regular physical activity, healthy diets, weight control, and avoiding smoking. The researchers also emphasise the need for cost-effective screening to detect prediabetes and undiagnosed diabetes, along with routine monitoring of diagnosed patients to prevent complications affecting the eyes, kidneys, and feet.
Early diagnosis is another critical gap. “People with diabetes are often treated too late, and lifestyle interventions can be more effective if the disease is detected early,” the authors write. Beyond healthcare delivery, the study highlights the role of social determinants such as food insecurity and humanitarian crises, calling for policy changes to improve access to healthy food, healthcare, and psychosocial support.
The researchers also note that newer medications, including GLP-1 receptor agonists such as Ozempic, could reduce the economic burden of diabetes by improving glycaemic control and lowering cardiovascular risks. While currently more accessible in high-income countries, wider adoption as costs decline could yield substantial public health benefits.
At the same time, the authors acknowledge limitations in their model. Diabetes-related expenditure data may overestimate or underestimate true costs, and economic burdens for 60 countries were imputed due to data gaps. The analysis also excludes undiagnosed diabetes, estimated at about 44.7 per cent of all cases, and does not account for indirect mortality linked to diabetes-related conditions, meaning the true economic impact is likely underestimated.
Why it matters
Beyond the figures, the economic burden of diabetes in India translates into lost lives, lost productivity, and deepening poverty. A 2021 study examining the impact of diabetes on India’s working-age population found that the disease significantly increases the risk of premature mortality and substantially reduces work productivity.
Using a life table model, researchers assessed individuals aged 20–59 years with diabetes and compared outcomes with a hypothetical cohort without the disease.
The study estimated that in 2017, around 5.44 crore people, 7.6 per cent of India’s working-age population, were living with diabetes. Over the course of their lives, diabetes was predicted to cause 85 lakh excess deaths, accounting for 62.7 per cent of all deaths in the cohort. It was also associated with 4.27 crore years of life lost, representing 7.4 per cent of total years lived, and 8.9 crore productivity-adjusted life years (PALYs) lost, amounting to 23.3 per cent of total estimated PALYs.
These losses translated into an estimated Rs 176.6 trillion in lost gross domestic product, equivalent to USD 2.6 trillion, or PPP-adjusted USD 9.8 trillion.
“Our study demonstrates the impact of diabetes on productivity loss and highlights the importance of health strategies aimed at the prevention of diabetes," it concluded.
More recent evidence from a 2025 study in urban Rohtak, Haryana, further illustrates how diabetes deepens economic vulnerability. The study reported that 10.14 per cent of patients experienced catastrophic health expenditure due to type 2 diabetes management, while 19.59 per cent faced impoverishment. After accounting for diabetes-related expenses, the normalised poverty gap increased by 4.34 per cent. The total annual cost of diabetes care was Rs 17,113 per patient, with out-of-pocket payments amounting to Rs 10,424.
Direct medical costs accounted for 54.65 per cent of total spending, followed by indirect costs such as lost income at 39.09 per cent, and direct non-medical costs at 6.26 per cent. Drugs alone made up 42.39 per cent of total expenditure. The study found that insulin therapy, diabetes-related complications, socio-economic status, and age at diagnosis were key predictors of economic burden. The authors concluded that the high cost of diabetes care is “responsible for significant catastrophic health expenditure, impoverishment and deepening poverty gap,” underscoring the urgent need for cost-effective management strategies.
The scale of the challenge is amplified by India’s growing share of the global diabetes population. A study published in The Lancet estimated that more than a quarter of the world’s diabetics live in India, reinforcing concerns that without strong preventive and early intervention strategies, the country’s economic burden will continue to rise.
Steps taken by the government
Recognising the growing threat posed by diabetes and other non-communicable diseases, the Ministry of Health and Family Welfare has launched several initiatives under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), implemented through the National Health Mission (NHM).
According to a ministry press release, “The Government of India, under the NP-NCD, provides technical and financial assistance to states and UTs through the National Health Mission (NHM). Support is allocated based on state and UT proposals with a focus on prevention and management of diabetes and other non-communicable diseases.”
As part of this effort, 743 District NCD Clinics and 6,237 Community Health Centre NCD Clinics have been established nationwide to strengthen local-level care and facilitate early diagnosis. A population-based screening programme targeting individuals over 30 years of age has been rolled out through Ayushman Arogya Mandirs, focusing on diabetes, hypertension, and select cancers. These centres also promote preventive health practices, conduct community wellness programmes, and offer free screening services.
Public awareness remains a key pillar of the government’s strategy. Awareness campaigns are organised on national and international health days using traditional and digital media platforms. The Ministry has also emphasised lifestyle modification as a cornerstone of diabetes prevention. “Healthy lifestyle promotion includes guidance from the Food Safety and Standards Authority of India (FSSAI) on nutrition,” the ministry noted, adding that initiatives such as the Fit India Movement and yoga programmes under the Ministry of AYUSH aim to encourage physical activity and healthier living.
To reduce the financial burden on vulnerable populations, the NHM’s Free Drugs Service Initiative provides essential medicines, including insulin, free of cost to economically weaker sections. Additionally, the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) has expanded access to affordable generic medicines and insulin across the country.
What experts say?
Dr Rajiv Kovil, Head of Diabetology and Weight Loss Expert at Zandra Healthcare, highlighted that the true impact of diabetes goes far beyond medical bills. He explained that most people, including governments, fail to appreciate both the direct and indirect costs associated with the disease. “Direct costs are related to treatment, medications, investigations, doctor visits, and complications, and today, about 80 per cent of these costs are out of pocket,” he said. Indirect costs, he added, include lost productivity, premature death, disability, absenteeism, and informal caregiving, all factors that remain largely unmeasured.
According to Dr Kovil, the economic consequences of diabetes are profound. “I had read somewhere that if we treat diabetes well, the GDP of India could go up by one per cent,” he said. He stressed that linking health to productivity is essential, yet today, health is rarely connected to work output. Corporates often measure employee time rather than productivity, and even wellness initiatives fall short of integrating health literacy or practical support.
Dr Kovil highlighted the need for corporate health programs to go beyond token wellness activities. “Corporates have wellness programs, but they rarely provide healthy food options, gym facilities, or structured health education,” he said. He suggested practical steps such as breakfast meetings instead of late-night dinners, scheduled lunch breaks, and access to nutritious food like fruits and dry fruits at the workplace. “If employees are healthier, their productivity naturally improves,” he explained.
He also pointed out the macroeconomic consequences of diabetes. “Diabetes is not just a health problem, it’s a macroeconomic challenge,” he said. Heart disease, amputations, chronic kidney disease, and vision loss are all common complications that contribute to catastrophic healthcare costs and reduced quality of life. “Every 20 seconds, one amputation occurs somewhere in the world due to diabetes. Mental health issues affect 40–50 per cent of patients, and liver problems are seen in 60–70 per cent. These complications create an enormous financial and social burden,” he noted.
On prevention, Dr Kovil emphasised early education and systemic changes. “Nutrition should be taught to children as a subject. Healthy food should be made affordable, and people spending on gyms or healthy food should receive subsidies or tax benefits,” he said. He also stressed that corporate initiatives should prioritise health literacy over superficial wellness programs: “Yoga or meditation without proper dietary guidance doesn’t make sense. Corporates must bridge the gap with proper health education to improve both employee well-being and productivity.”
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.
