Diabetes has become one of India's biggest public health challenges, affecting millions of families across the country. According to the Indian Council of Medical Research (ICMR), more than 11% of Indian adults, over 100 million people, are living with diabetes, while another 15% have prediabetes, putting them at high risk of developing the chronic condition. What is even more concerning is that nearly four in 10 people with diabetes do not know they have it until serious complications appear.

Diabetes is no longer limited to cities or wealthy households. Rural India is also seeing a sharp rise in cases due to changing diets, physical inactivity and delayed diagnosis. If left poorly controlled, diabetes can increase the risk of heart disease, stroke, kidney failure, vision loss, nerve damage and even amputations, making early diagnosis and the right treatment more important than ever.

For decades, metformin has been the backbone of type 2 diabetes treatment. It is affordable, has a long safety record and remains the first-choice medicine in India as recommended by ICMR and RSSDI guidelines. However, newer weekly injectable medicines such as Ozempic and Mounjaro have gained attention for offering better blood sugar control, significant weight loss and better heart and kidney benefits in selected patients.

As these medicines become more widely available, many people wonder whether metformin is now outdated or whether injectables are the better option. Diabetes specialists say the answer is not so simple. The best treatment depends on each person's age, weight, overall health and medical conditions. Rather than replacing metformin, newer injectables are often used alongside it in carefully selected patients under medical supervision.

Metformin Is Still The Foundation

According to diabetes expert Dr Anoop Mishra, Executive Chairman of Fortis C-DOC Hospital for Diabetes and Allied Sciences, metformin continues to be the cornerstone of diabetes management. Around 90% of patients seen in routine clinical practice are still prescribed metformin, while only a smaller group requires injectable medicines.

Metformin has remained the first-line treatment for over four decades because it effectively lowers blood sugar, is inexpensive and has a very low risk of causing dangerously low blood sugar levels. It mainly works by reducing the amount of glucose produced by the liver. It also has beneficial effects on the gut and may offer additional long-term health benefits beyond diabetes control.

Why Are Injectables Becoming Popular?

Injectable medicines like Ozempic and Mounjaro belong to a newer generation of diabetes treatments. Besides lowering blood sugar, they help people lose weight and may reduce the risk of heart and kidney complications.

However, Dr Mishra stresses on the fact that these medicines are not suitable for everyone. They are mainly recommended for people with both type 2 diabetes and obesity, especially those who meet body mass index (BMI) criteria. Since Indians often develop diabetes at lower body weights than Western populations, doctors believe BMI cut-offs may need to be lower for Indian patients. For many people, injectables are not a replacement for metformin but an additional treatment that provides greater overall benefits.

Treatment Must Be Personalised

Diabetes treatment should never follow a one-size-fits-all approach. A young adult with obesity and diabetes may benefit significantly from injectable medicines, while an older person with diabetes but normal body weight may not need weight-loss treatment at all. Dr Mishra points out that nearly 30% of Indians with diabetes are not obese. For such people, reducing weight is not the treatment goal, making injectables less appropriate.

Doctors consider several factors before choosing medicines, including age, weight, existing heart or kidney disease, overall health and treatment goals.

Important Facts Patients Should Know

Although injectable medicines are effective, they are powerful drugs that require careful medical supervision, says Dr Mishra. Patients need to understand possible side effects, gradual dose increases and the commitment to long-term treatment before starting them.

"In people with simple obesity without diabetes, we have to achieve target weight loss, so 10 kg, 15 kg, 20 kg. Whenever we achieve that, we start tapering out these doses. In people with diabetes and obesity, possibly longer because we have to control diabetes very well. And once we control diabetes, the requirement for other drugs comes down," says Dr Mishra.

Patients should also know that stopping treatment may lead to weight regain, making lifestyle changes essential alongside medication. "And this must also be known that once we stop the drug, there's always the possibility of weight regain, for which, a serious conversation with your physician is required right in the beginning and once you're stopping the drug," adds Dr Mishra.

Common Diabetes Myths Debunked

Several myths continue to confuse patients about diabetes treatment.

Metformin is far from outdated. It remains one of the most trusted and well-tested diabetes medicines available. Similarly, injectable medicines are not meant only for weight loss. They also improve blood sugar control, reduce fat accumulation in organs like the liver and may protect the heart and kidneys.

Another common misconception is that diabetes is only about high blood sugar. In reality, the disease can damage nearly every major organ, including the eyes, nerves, kidneys, heart and liver if left uncontrolled.

Experts also caution against relying only on HbA1c to judge diabetes. While HbA1c helps monitor long-term sugar control, diagnosis should be confirmed using appropriate blood glucose testing as advised by a doctor. Dr Mishra suggests the oral glucose tolerance test.

Technology Is Improving For Diabetes Care

Modern technology is making diabetes management easier. Insulin pumps can deliver insulin continuously for those who need intensive insulin therapy. Smart insulin pens help track doses and remind users when injections are missed. Continuous glucose monitors (CGMs) provide round-the-clock glucose readings, helping people understand how food, exercise, stress and sleep affect their blood sugar levels.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.