OBJECTIVES: India has the largest diabetes population in the world.  Our objective was to assess practice patterns regarding management of Type 2 Diabetes mellitus (DM) in a private clinic in Mumbai, India. METHODS: A retrospective cohort of 350 DM patients was analyzed.  Patients were selected if they were taking any anti-diabetic medication for at least 2 years prior to the index date, age greater than 40 years, and had at least 2 documented blood glucose readings over one year. Additional data regarding patient demographics, medical history, diabetes treatment, blood glucose levels, co-morbid conditions, and diabetes-related complications were also obtained. RESULTS: The mean age of patients was 57 years and 55% were male.  Mean BMI was 27.7.  Most patients (86%) had never smoked.  Patients were diagnosed with diabetes for an average of 13.5 years. Patients were treated by oral agents (69%), insulin (21%) and oral agents + insulin (10%).  Adequate glycemic control, as defined by the ADA guideline (HbA1c<7%, FPG <126mg/dl, PPG <200 mg/dl) was not achieved by 68% of total patients, 62% of those who were on oral agents, 26% on insulin and 12% on orals + insulin. Retinopathy (62%) was the most prevalent diabetes-related complication, while the majority of patients (80%) reported having at least 1 complication.  More than half (53%) of patients had hypertension, the most common co-morbidity, followed by dyslipidemia (15%). CONCLUSIONS: Patients in this cohort visited the clinic at least twice a year but the outcomes are unsatisfactory with a large percentage of patients not achieving adequate glycemic control and having high rates of diabetes-related complications. With India having one of the fastest growing diabetes populations in the world, these findings suggest that there is a dire need for educational and disease management programs that promote better patient self-care practices and tighter glucose control.