This article is part of South First's year-long Beat Obesity, Lower Diabetes (BOLD) series, an attempt to keep the lens steady, week-after-week analysis on what is changing, what is not, and what must.
Published Jan 12, 2026 | 7:00 AM ⚊ Updated Jan 12, 2026 | 7:00 AM
Synopsis: Kerala’s 19.1 percent diabetes mortality rate may be the most accurate capture of reality. Uttar Pradesh’s 0.5 percent rate almost certainly represents severe underreporting rather than genuinely lower mortality.
Kerala recorded 6,624 diabetes deaths in 2023, representing 19.1 percent of all medically certified deaths in the state. Diabetes is the cause of one in every five doctor-certified deaths in the southern state.
The National Family Health Survey (NFHS) conducted in Kerala between 2019 and 2021 found that 4.1 percent of women and 4.0 percent of men had diabetes. But when ICMR-INDIAB tested blood glucose directly, it found 25.5 percent of the population living with diabetes.
Contrast Kerala’s figures with those of the most populous Indian state. Uttar Pradesh recorded 361 diabetes deaths in 2023, or 0.5 percent of its medically certified deaths. One in every 200 certified deaths listed diabetes as the cause.
NFHS-5 revealed that 1.3 percent of women and 1.5 percent of men in Uttar Pradesh had diabetes. ICMR-INDIAB testing found a prevalence of 4.8 percent.
Nationally, diabetes accounted for 58,986 deaths out of 1,900,956 medically certified deaths in 2023, a rate of 3.1 percent.
The ICMR-INDIAB study, which surveyed 31 states and Union Territories, estimated that 101 million people were living with diabetes in India and another 136 million hover in the prediabetes territory. The disease, the survey noted, concentrated in specific geographies.
Goa showed a 26.4 percent diabetes prevalence. Puducherry registered 26.3 percent. Kerala recorded 25.5 percent. Chandigarh showed 20.4 percent, and Delhi, 17.8 percent.
Tamil Nadu recorded 14.4 percent diabetes prevalence in the ICMR-INDIAB data. The state recorded 21,986 diabetes deaths in 2023, the highest absolute number in India. Yet the figure represented only 8.1 percent of Tamil Nadu’s medically certified deaths, less than half of Kerala’s rate, despite similar population health profiles.
Southern states combined account for 58.8 percent of all diabetes deaths in India, despite having only 33.3 percent of medically certified deaths. Kerala and Tamil Nadu together contributed 48.5 percent of India’s recorded diabetes mortality.
The NFHS 2019-2021 asked people whether doctors had diagnosed them with diabetes. Nationally, 1.9 percent of women and 2.1 percent of men aged 15 to 49 reported having diabetes.
These figures sit far below ICMR-INDIAB estimates. Kerala showed 4.1 percent of women self-reporting diabetes in NFHS-5, the highest rate among states. Men report 4.0 percent. Yet ICMR-INDIAB testing found 25.5 percent prevalence when it measured blood glucose directly.
The gap between self-reported and tested prevalence suggested that most people with diabetes either didn’t know they had it or felt it unworthy to report in surveys.
Goa showed 4.1 percent of women self-reporting diabetes. Puducherry registered 4.0 percent for women and 3.9 percent for men. Andhra Pradesh showed 3.4 percent for women and 3.5 percent for men. Delhi registered 2.3 percent for women and 4.2 percent for men.
At the lower end, Nagaland showed 0.8 percent for women and 0.7 percent for men self-reporting diabetes. Chhattisgarh recorded 0.9 percent for women. Madhya Pradesh showed 1.0 percent for women.
ICMR-INDIAB measured both diabetes and prediabetes. The prediabetes numbers exceeded diabetes in most states, indicating millions more would likely develop full diabetes without intervention.
Sikkim showed the highest prediabetes prevalence at 31.3 percent, with only 12.8 percent showing diabetes. The ratio stood at 1 to 2.4, meaning for every person with diabetes, 2.4 more hovered in prediabetes territory.
Uttar Pradesh showed 4.8 percent diabetes prevalence but 18.0 percent prediabetes, a ratio of 1 to 3.8. Rajasthan registered 6.8 percent diabetes and 16.1 percent prediabetes. Madhya Pradesh showed 7.1 percent diabetes and 20.1 percent prediabetes, a ratio of 1:2.8.
In contrast, states with higher diabetes showed lower prediabetes ratios. Kerala’s ratio stood at 1 to 0.7, with 25.5 percent diabetes and 18.3 percent prediabetes. Tamil Nadu showed 1 to 0.7. Punjab registered 1 to 0.7. Goa showed 1 to 0.8.
The pattern suggested the high-prevalence states had converted much of their prediabetes population into diabetes, while lower-prevalence states were facing a coming wave as their prediabetes populations progressed.
NFHS-5 data showed diabetes prevalence climbing steeply with age. Among women aged 15 to 19, only 0.4 percent reported having diabetes. By age 35 to 49, that figure reached 3.9 percent. Men aged 50 to 54 showed 9.5 percent prevalence, double the rate in five years.
Wealth patterns emerged clearly. Among women in the poorest households, 1.1 percent reported diabetes. In the wealthiest households, 2.7 percent reported it. Men showed a steeper gradient, from 1.1 percent in the poorest quintile to 3.1 percent in the richest.
Urban areas showed higher prevalence. Women reported 2.6 percent in cities versus 1.5 percent in villages. Men showed 2.5 percent urban and 1.8 percent rural.
NFHS-5 asked people who reported diabetes whether they had sought treatment. Nationally, 80.7 percent of women with diabetes had sought treatment. Men showed lower rates at 71.5 percent.
Treatment-seeking improves with wealth: Among women with diabetes in the poorest households, 68.1 percent sought treatment. In the wealthiest households, 87.2 percent sought treatment. Men showed the same pattern, from 61.4 percent to 80.3 percent.
Urban populations seek consistent treatment: Among urban women with diabetes, 85.1 percent reported receiving treatment. In the case of rural women, 77.1 percent took treatment.
Age affects treatment patterns. Among women aged 15 to 19 with diabetes, only 52.0 per cent sought treatment. Among those aged 35 to 49, the figure reached 85.8 percent.
Scheduled tribes showed the lowest treatment-seeking among caste groups at 69.6 percent for women, compared to 83.1 percent in general categories.
The 2023 mortality data showed patterns that suggest systematic underreporting rather than genuine disease distribution.
Maharashtra recorded 8,456 diabetes deaths, just 2.6 percent of its medically certified deaths. Yet ICMR-INDIAB found 10.3 percent diabetes prevalence in that state.
Uttar Pradesh recorded 361 diabetes deaths out of 70,771 medically certified deaths, a rate of 0.5 percent. The state has a population exceeding 200 million. ICMR-INDIAB found 4.8 percent diabetes prevalence and 18.0 percent prediabetes prevalence.
Bihar recorded 144 diabetes deaths, 0.6 percent of its medically certified deaths. ICMR-INDIAB found a 5.4 percent diabetes prevalence. Madhya Pradesh recorded 175 diabetes deaths, 0.3 percent of medically certified deaths. ICMR-INDIAB found a 7.1 percent diabetes prevalence and 20.1 percent prediabetes.
These large Hindi-belt states account for a combined population exceeding 450 million, but contributed less than 2 percent to national diabetes mortality records. The pattern suggested deaths from diabetes complications were attributed to immediate causes like heart failure or kidney failure, leaving diabetes off the death certificate.
Delhi showed interesting contrasts. ICMR-INDIAB found a 17.8 percent diabetes prevalence. NFHS-5 showed 2.3 percent of women and 4.2 percent of men self-reporting it. The 2023 mortality data recorded 2,931 diabetes deaths, 3.4 percent of medically certified deaths. The gap between the tested prevalence and self-reported prevalence suggested that most people don’t know their status.
West Bengal recorded 2,125 diabetes deaths, 1.6 percent of its medically certified deaths. Yet ICMR-INDIAB found 13.7 percent diabetes prevalence. The state has high disease burden but low recorded mortality, pointing to certification gaps.
Goa showed 26.4 percent tested prevalence, 4.1 percent self-reporting, and 1.8 percent mortality rate. The gap between Goa and Kerala in mortality rates, despite similar prevalence, suggested that Kerala captured diabetes on death certificates far more thoroughly.
The three surveys measured different aspects of India’s diabetes burden using different methods. ICMR-INDIAB tested blood glucose directly and found 101 million with diabetes and 136 million with prediabetes. NFHS-5 asked whether doctors had diagnosed them with diabetes. The mortality data captured 58,986 diabetes deaths among 1,900,956 medically certified deaths.
Together they revealed that diabetes concentrates in specific geographies, correlates with wealth and urbanisation, progresses with age, and kills unevenly depending on where deaths get recorded and how thoroughly certificates list underlying causes.
The data also pointed to enormous gaps. Most people with diabetes were unaware of their condition, based on the difference between tested and self-reported rates. Many who knew didn’t seek treatment consistently, based on the 20 to 30 percent who reported having diabetes but not accessing care. And deaths from diabetes were recorded inconsistently, based on the implausible variations between states with similar prevalence.
Kerala’s 19.1 percent diabetes mortality rate might be the most accurate capture of how many people actually die with diabetes, contributing to their deaths. Uttar Pradesh’s 0.5 percent rate almost certainly represents severe underreporting rather than genuinely lower mortality.
The three datasets established different baselines. ICMR-INDIAB showed disease prevalence. NFHS-5 showed awareness and treatment-seeking. Mortality data showed how deaths were recorded.
None alone tells the full story, but together they map a disease that affects over 100 million people, threatens 136 million more, and kills in ways that health systems struggle to measure consistently.
(Edited by Majnu Babu).
