India is the leading source of new citizens and medical professionals for advanced economies, according to the International Migration Outlook 2025 released by the Organization for Economic Co-operation and Development (OECD). The report states that in 2023, approximately 225 000 Indian citizens acquired the nationality of an OECD member country. This figure is a record for India and is the highest number among all countries of origin, surpassing the Philippines (132 000) and China (92 400). This continues an upward trend, rising from 214 000 in 2022 and 200 000 in 2021. A major portion of this migration is by healthcare professionals. The report highlights that India is now the largest source of migrant doctors and the second-largest source of migrant nurses employed in OECD nations. Since the 2000–01 period, the number of Indian-born doctors working in these countries has increased by 76% to nearly 99 000, while the number of Indian-born nurses has increased by 435% to over 122 000.

The UK, the USA, Canada, and Australia remain the top destinations. The reliance on Indian talent is particularly strong in the UK, where India-trained professionals comprise 23% of foreign-trained doctors and 18% of foreign-trained nurses. In the USA, India-trained doctors account for 8% of the foreign-trained workforce. The OECD attributes this surge to India’s robust medical education system, English-language proficiency, and targeted recruitment drives by developed nations, which are facing structural healthcare shortages. The report also raises concerns about ‘brain drain.’ India appears on the WHO’s Health Workforce Support and Safeguards List, identifying it as a country facing its own critical workforce shortages.

Despite the demand, Indian professionals still face barriers abroad. The report notes that licensing delays and opaque credentialing often hinder integration and force many highly qualified doctors and nurses into lower-skilled positions. The OECD concludes that while Indian professionals have become a vital lifeline for western health systems, there is an urgent need for balanced policies. These policies must support ethical international mobility without compromising India’s ability to meet its domestic healthcare needs.

ALLADI MOHAN , Tirupati, Andhra Pradesh

ORCID iD: 0000-0002-3214-9884

Despite a consistent decline in tuberculosis (TB) trends, India remains far from achieving its ambitious goal of eliminating TB by 2025 (a target set in 2018), according to the Global TB Report 2025 released on November 12.

As per the Global TB Report 2025, in 2024, India recorded approximately 271 000 TB cases and over 300 000 deaths and is one of the leading contributors to the global TB burden. India has achieved only a 21% reduction in new cases and a 28% reduction in deaths between 2015 and 2024. These figures fall short of the End TB milestones set for 2025, which required a 50% reduction in incidence and a 75% reduction in deaths.

However, the report highlights major improvements in diagnosis and treatment coverage. In 2024, India diagnosed a record-breaking 2 618 000 cases, narrowing the gap between estimated and diagnosed patients to just about 100 000 ‘missing cases.’ The treatment coverage surged to 92% in 2024, a massive leap from 53% in 2015. This improvement is attributed to decentralised services, community mobilization, and the adoption of newer technologies.

Despite these advancements, challenges persist. India continues to account for nearly one-third of global drug-resistant TB cases, with 127 000 people affected in 2024. Experts cite the diversion of resources during the Covid-19 pandemic, treatment non-adherence, and environmental factors like air pollution as important setbacks. Additionally, the rise of comorbid conditions such as diabetes contributed to an estimated 320 000 TB cases in 2024.

ALLADI MOHAN , Tirupati, Andhra Pradesh

ORCID iD: 0000-0002-3214-9884

Substantial faculty vacancies have been documented across several government medical colleges in Madhya Pradesh, with some institutions reportedly operating with up to 90% of sanctioned teaching posts vacant. The shortages appear particularly pronounced in recently established colleges, where posts of Professors, Associate Professors and Assistant Professors remain largely unfilled.

Available information in November 2025 indicates that only a small proportion of the state’s 19 government medical colleges currently maintain adequate staffing across essential departments. Newer colleges in districts such as Sheopur and Singrauli are operating with minimal faculty strength, while older institutions continue to face major vacancies in pre-clinical and para-clinical departments, which form the academic foundation of the MBBS curriculum. Several clinical departments have also reported shortages, limiting opportunities for structured bedside teaching.

The effect on undergraduate medical education has been considerable. In multiple colleges, teaching has shifted predominantly to online or recorded sessions due to the absence of faculty for in-person instruction. Practical training has been inconsistent, with under-utilised laboratories, non-functional skill centres and limited demonstration sessions. Students have expressed concern about reduced clinical exposure, which remains a core component of competency-based medical education.

These developments reflect broader structural challenges previously discussed in the Journal, where earlier commentaries have highlighted long-standing issues in faculty recruitment, distribution and retention in government medical colleges. Those discussions noted that rapid expansion of medical institutions, without proportionate strengthening of human resources and robust recruitment pathways, risks creating persistent gaps in teaching capacity—particularly in non-urban regions. The current situation in Madhya Pradesh aligns with these national observations.

Dr V. Deepika (Associate Professor, Department of Physiology, Sri Manakula Vinayagar Medical College & Hospital, Puducherry) emailed this correspondent, ‘Persistent faculty shortages in new government medical colleges risk the suboptimal student–teacher ratios, overburdening the existing faculties, and reducing the quality of bedside teaching, mentorship and formative feedback. All these factors ultimately compromise the quality, continuity and relevance of competency-based medical education (CBME). This requires deliberate policies and institutional strategies to entrench the developing two-tier system, where in newer colleges, students will receive a thinner educational experience despite an identical regulatory curriculum framework.

In order to stabilise and strengthen the faculty capacity, there is a need to mix structural and incentive-based strategic planning: streamlining and time-bound recruitment processes, protected academic posts with clear career progression, rural area incentives and flexible norms without diluting the standards of medical education. Parallel investments in faculty development programmes (FDPs), mentoring the young faculty and transparent workload policies are also essential to match the student seat expansion with a motivated teaching workforce.’

The ongoing shortages have important implications for the quality of medical training and the adequacy of the future healthcare workforce. Ensuring robust teaching capacity in government medical colleges will require coordinated policy measures, timely appointments and sustained regulatory oversight to align institutional expansion with available human resources.

NISCHAL P.M. , Mysuru, Karnataka

ORCID iD: 0000-0003-3491-5500

A recent national assessment, as reported in late November 2025, indicates that approximately one in four Indians is now obese. The findings describe an increase in prevalence of obesity across both urban and rural regions, accompanied by an estimated annual economic loss of about US$ 29 billion due to reduced productivity, increased healthcare expenditure and obesity-associated morbidity.

Available information suggests that the prevalence of overweight and obesity has risen consistently over the past decade. While metropolitan areas continue to contribute substantially to the overall burden, semi-urban and rural districts have shown marked increases, reflecting shifts in dietary patterns, declining physical activity levels and changing occupational environments. The assessment notes that obesity is no longer confined to specific demographic or socio-economic groups, underscoring the scale of the public health challenge.

The projected economic loss incorporates both direct and indirect costs. Direct costs arise from higher utilization of healthcare services, including outpatient consultations, diagnostic investigations, chronic disease management and hospital admissions for complications such as cardiovascular disease and diabetes. Indirect costs include reduced workforce productivity, absenteeism, premature retirement and loss of future income due to obesity-related morbidity and mortality. Collectively, these factors contribute to a substantial economic burden that is expected to increase without preventive interventions.

The assessment also reports regional variability, with certain states demonstrating higher prevalence rates than others. The rise in obesity among younger age groups is of particular concern. Public health specialists have stressed the need for stronger surveillance systems to monitor shifts in weight patterns and associated risk factors, particularly in high-burden districts.

Dr Anoop Misra (Chairman, National Diabetes, Obesity and Cholesterol Foundation; President, Diabetes Foundation [India]) emailed this correspondent, ‘ICMR has already created a national task force on obesity… this will help shape evidence-based treatment and public-health strategies. India now needs accelerated action from multiple stakeholders, with far greater consciousness among all healthcare providers to treat obesity as a serious disease. The recently revised Indian obesity guidelines—giving primacy to abdominal obesity, incorporating mechanical symptoms and obesity-related diseases, and being simple to use in any setting—should guide practice. Immediate priorities include strong food-environment policies, a focused pulse-polio–like programme, early detection in primary care, and multidisciplinary weight-management services. Without rapid national and state action, health and economic costs will escalate sharply.’

The expanding prevalence of obesity and its associated economic burden represent an important public health and economic concern for India. Without coordinated and sustained policy action, the health and economic consequences are likely to intensify over the coming decade. The current findings highlight the need for a comprehensive national response that aligns public health priorities with long-term economic resilience.

NISCHAL P.M. , Mysuru, Karnataka

ORCID iD: 0000-0003-3491-5500

Continuous glucose monitoring (CGM) devices have become the standard of care for individuals with diabetes, with their increasing availability and use globally, although with some variation as per resource settings.

In November 2025, Abbott Diabetes Care, a leading maker of prescription CGM devices under the name of ‘FreeStyle Libre’ alerted customers, healthcare providers and distributors regarding an issue of incorrect low glucose readings by ‘FreeStyle Libre 3’ sensor and ‘FreeStyle Libre 3 Plus’ sensor of some batches with specific unique device identifiers. Patients were asked to immediately discontinue the use of affected devices and dispose them, with a provision for free replacement of the affected sensors by the manufacturer. The company made a press release to this effect on 24 November 2025, and subsequently, the US Food and Drug Administration also released an Early Alert communication for the affected medical device. Abbott informed that the issue had affected a single production line out of many, and it had been identified and resolved. The company was continuing to produce the product after resolving the issue. The FreeStyle Libre 3 readers and mobile app were not impacted, nor were the other Libre products.

The impact of this has been far-reaching. The company estimated that approximately 3 million such sensors are from the affected production line, half of which may have already expired or been used. They further declared having received reports of 736 severe adverse events and 7 deaths globally, potentially associated with the issue. This was an extremely high-risk situation, particularly for people with diabetes on insulin therapy who adjust their doses as per the glucose readings, and also for those using automated insulin delivery (AID) devices that depend on a CGM-informed algorithm for modulating the insulin delivery. The consumers were advised to use a blood glucose monitor or the built-in meter in the FreeStyle Libre 3 reader for making treatment decisions when the sensor readings do not match symptoms or expectations.

The key role of technology in diabetes care has been undisputed, and in fact, the American Diabetes Association’s (ADA) annual update on Standard of Care for Diabetes has included a dedicated section on Diabetes Technology since 2019. The literature provides ample evidence in favour of CGM devices with improved glycaemic management, lowering of HbA1c levels and fewer hypo/hyperglycaemia episodes. Further, individuals with type 2 diabetes who are not on insulin have also been found to benefit from the use of CGM devices. The recently released Standard of Care for Diabetes 2026 emphasises early initiation of use of CGM devices, with recommendations on providing guidance regarding prescribing, initiating, and following a CGM device. The recommendations also reinforce the importance of ensuring that individuals using CGM also have access to blood glucose monitoring (American Diabetes Association Professional Practice Committee for Diabetes. 7. Diabetes technology: Standards of Care in Diabetes. Diabetes Care 2026;49: S150–S165).

Technology does have its downsides, and sometimes this can be unacceptable. The present event of defective devices having been used by numerous individuals makes a compelling case for a review of advisories and a stronger emphasis on adherence to recalibrations with traditional blood glucose monitors and attention to clinical situations or symptoms. The overdependence on technology for a health matter such as diabetes perhaps needs a conscious check. The monitoring of such devices by the materio-vigilance programmes in place may also need to be more proactive.

JYOTI NATH MODI , Bhopal, Madhya Pradesh

ORCID iD: 0000-0002-0626-1637