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Diabetes affects more than 420 million people worldwide, with India contributing to over 77 million cases, according to the World Health Organization (WHO). Globally, diabetes is a major cause of visual impairments, kidney failure, heart attacks, stroke, and lower limb amputations. While India invests in diabetes screening and treatment, experts say the long-term disabling effects — especially complications like neuropathy, retinopathy and amputations — are inadequately addressed by healthcare system and disability welfare mechanisms.
Overlooked diabetes-associated disabilities
According to Pearlsy Grace Rajan, senior consultant in internal medicine at Rela Hospital, Chennai, peripheral neuropathy, diabetic retinopathy and nephropathy are the most common diabetes-related complications, alongside cardiovascular dysfunction and autonomic nerve damage. “Nerve damage can make patients numb to injuries. They don’t realise when they step on sharp objects, leading to wounds and infections that may result in amputations. Retinopathy is one of the leading causes of adult vision loss in India,” she said.
Mayur Mewada, general physician at K.J. Somaiya Hospital, Mumbai, said peripheral neuropathy impairs mobility and balance, while limb amputations and blindness drastically reduce independence. “Unfortunately, these complications are often viewed as natural extensions of the disease rather than life-altering disabilities.”
Manoj Khatri, clinical lead in Vitreo-Retina at Dr. Agarwal’s Eye Hospital, Chennai, noted that untreated diabetic retinopathy progresses from vision impairment to irreversible blindness. “This is a disability that is eligible for certification, but most patients are unaware. Many don’t even think of vision loss caused by diabetes as something they can receive support for,” he said, stressing that medical teams must guide patients toward certification and available schemes.
Chronic neuropathic pain, foot drop, gait imbalance and functional dependence, especially in older adults, are among the lesser-discussed outcomes that drastically affect quality of life. Some of these complications remain invisible to outsiders but are severely disabling.
Rehabilitation is available, but inaccessible
Despite rising numbers of diabetes-related disabilities like physical and mental health impairments, rehabilitation remains an afterthought. In India, especially in rural areas, patients are often discharged after acute treatment with no referral to rehabilitation. Services like physiotherapy, prosthetic fitting or psychological counselling are rarely integrated into the care continuum.
“Long-term disability management is almost entirely absent from routine diabetes care,” said Sridevi Paladugu, consultant endocrinologist at Apollo Sugar Clinic, Hyderabad. “Many services like low-vision aids, pain management, and support groups are concentrated in cities, and even there, they’re not routinely offered.”
Elamthalir I., consultant diabetologist at SRM Global Hospitals, Chennai, pointed out that even when rehabilitation services do exist, cost and lack of awareness keep most patients from accessing them. “Our system focuses on controlling sugar levels and acute care, but not on what happens after complications set in,” she said.
R. Sundararaman, senior consultant in internal medicine at SIMS Hospital, Chennai, added that in rural areas, rehabilitation is virtually non-existent. “Patients are discharged with a prescription but no pathway for regaining function or independence.”
Disability laws, realities and barriers
While India’s Rights of Persons with Disabilities (RPWD) Act, 2016 recognises conditions like low vision and locomotor disability, it does not explicitly list diabetes. This creates a legal gap. Dr. Rajan noted that while complications such as blindness and amputation may be technically certifiable, others like neuropathy often go unrecognised unless significantly disabling. “Certification depends on severity and the discretion of officials. Many patients simply give up,” she said.
Dr. Khatri pointed out that schemes like Ayushman Bharat and some State initiatives do cover diabetes care, but rarely extend to long-term disability benefits. “Many patients don’t realise they are entitled to help because the language of policy doesn’t clearly include them,” he said.
According to Dr. Sundararaman, patients face not just bureaucratic hurdles but also emotional and social ones. “There’s a stigma to being called disabled, especially for elderly and patients from rural parts of India. Add to that the paperwork, multiple visits and the need to ‘prove’ invisible conditions like hypoglycaemia or nerve pain — it becomes discouraging.”
Dr. Rajan added that most health workers are not trained to assist with disability claims. “There is limited awareness even among doctors. This leaves patients with severe limitations but no formal support,” she said.
Call for urgent reform and integration
Ranjit Unnikrishnan, consultant diabetologist and vice chairman of Dr. Mohan’s Diabetes Specialities Centre, Chennai, pointed out that there is no structured pathway for disability screening or rehabilitation. Services such as gait training, vision therapy, prosthetic support, or occupational rehabilitation are either unavailable or not routinely offered, especially in public hospitals. In rural and semi-urban areas, these services are virtually non-existent, he said
Dr. Unnikrishnan also noted that neither patients nor clinicians are consistently aware that complications such as limb amputation or diabetes associated visionloss may qualify for disability certification under the RPWD Act. “There is no automatic referral process. Many eligible individuals fall through the cracks due to lack of awareness and bureaucratic hurdles,” he said.
Dr. Elamthalir stressed that India must explicitly recognise diabetes-related complications in its disability assessment protocols, integrate rehabilitation into diabetes clinics, particularly in the public sector, and ensure that insurance schemes and public health programmes include long-term disability care and not just blood sugar control.
Experts called for community-based rehabilitation programmes with rural outreach and training for primary care providers to detect functional decline early and refer patients appropriately.
Improved access to rehabilitation programmes
According to the WHO, rehabilitation is a key pillar of Universal Health Coverage, yet more than half the global population that needs it doesn’t receive it. The Global Burden of Disease Study estimated that diabetes-related lower-extremity complications, including neuropathy, ulcers, and amputations, accounted for over 16 million years lived with disability worldwide as of 2016.
Despite this, few countries including India have integrated rehabilitation and certification pathways into standard diabetes care. “We need automatic referrals for disability evaluation when complications arise. Rural outreach and free rehabiliation should be part of public health,” said Dr. Elamthalir.
“Diabetes is not just a chronic disease; it’s one that can change how a person moves, sees, and lives. We’re ignoring this long-term impact,” experts said. As India’s diabetes burden continues to rise, experts warn that without structural reform, many people with disabling complications will continue to fall through the cracks.
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