Gradual decline in infectious disease has led to an increase in the life span of Indians. Along with this, change in lifestyle has contributed immensely to the rise in non-communicable diseases like diabetes mellitus in epidemic proportions. Some unique features of this epidemic is gradual decline in the age of onset, progressive narrowing of urban to rural divide, rising prevalence of prediabetes, and increasing conversion of prediabetes to an overt stage. Notwithstanding these unique features that are common across the country, there are stark disparities in the prevalence rate and healthcare delivery provisions amongst different geographic regions of the country. Through extensive literature search, this review tries to analyze the probable causal mechanism of rising prevalence of diabetes and highlights the features unique to India. It also tries to objectively narrate the disparities amongst the geographic regions.