India is facing a rare convergence of public health need, scientific progress and economic opportunity. More than 100 million adults live with diabetes and another 136 million with pre-diabetes. At the same time, GLP-1 therapies, initially developed to control blood sugar, have demonstrated reductions in cardiovascular events, kidney disease and mortality in clinical trials. For appropriately selected patients, they represent an advance in preventing the complications that make diabetes so costly for families and the health system. The WHO’s decision in 2025 to include GLP-1 therapies in its Essential Medicines List for high-risk people with type 2 diabetes reinforces the clinical case.
International obesity thresholds can miss many Indians who develop diabetes and cardiovascular disease at much lower levels of body weight. Eligibility, therefore, must reflect South Asian physiology and India’s distinctive disease burden.
Competition has reduced prices and could push them down further. But even a monthly cost of ₹1,300 or ₹1,500 is beyond the reach of most Indian households when treatment continues for years. Diabetes-related complications impose enormous treatment costs, reduce household income, push family members into caregiving and land vulnerable families in debt. The real comparison, thus, is, between timely treatment and the larger future costs of preventable complications.
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A carefully targeted programme could offer reasonable value for public spending. Available estimates remain provisional, requiring India to aggregate its own clinical and economic evidence before making a large national commitment. The country should begin with a controlled, phased access programme focused on people with type 2 diabetes who also have cardiovascular or kidney disease, and other high-risk groups. A four- or five-state pilot could test eligibility criteria, clinical protocols, procurement arrangements, adherence, safety, and cost-effectiveness under Indian conditions. Expansion should depend on demonstrated outcomes, not commercial pressure. The Ayushman Bharat Digital Mission can support longitudinal records -- prescriptions, dispensing, laboratory results, side effects, and treatment discontinuation.
{{/usCountry}}A carefully targeted programme could offer reasonable value for public spending. Available estimates remain provisional, requiring India to aggregate its own clinical and economic evidence before making a large national commitment. The country should begin with a controlled, phased access programme focused on people with type 2 diabetes who also have cardiovascular or kidney disease, and other high-risk groups. A four- or five-state pilot could test eligibility criteria, clinical protocols, procurement arrangements, adherence, safety, and cost-effectiveness under Indian conditions. Expansion should depend on demonstrated outcomes, not commercial pressure. The Ayushman Bharat Digital Mission can support longitudinal records -- prescriptions, dispensing, laboratory results, side effects, and treatment discontinuation.
{{/usCountry}}Those covered under the programme will need gradual dose escalation, monitoring for adverse effects and advice on diet, physical activity. International experience also shows high discontinuation rates, often because patients cannot manage side effects or afford continued treatment. Without strong follow-up, public expenditure will rise without producing the expected health gains.
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There must also be firm safeguards against inappropriate prescribing and cosmetic use. Clear exclusion criteria, real-time pharmacovigilance and an independent safety board empowered to pause the programme should be built. India excels at manufacturing affordable versions of medicines discovered elsewhere; GLP-1 therapies offer an opportunity to go further — from manufacturer to innovator and generator of globally relevant evidence.
Government need not carry the entire early risk. Philanthropic and catalytic capital can finance India-specific trials, protocol development, affordability pilots, adherence systems and independent evaluation. Domestic manufacturers can contribute through competitive procurement and outcome-linked arrangements. Government must, however, retain stewardship over clinical standards, patient safety and data governance. Lifestyle changes, while important, alone can’t address India’s diabetes epidemic. The need is to expand access to GLP-1 therapies gradually and scale only when results justify it.
Indu Bhushan is a former IAS officer and founding CEO, National Health Authority. The views are personal