Aim <p>This study aims to analyse gender-specific trends in diabetes and modifiable risk factors (MRFs) over time across various socio-economic and demographic groups. In addition, this study looked into MRFs exposure among diabetes and non-diabetes patients across women and men.</p> Subjects and methods <p>This study used cross-sectional data from the National Family Health Survey (NFHS) rounds: NFHS-3 (2006), NFHS-4 (2016), and NFHS-5 (2021). Multivariate logistic and negative binomial regression analyses were conducted to examine gender-specific associations between diabetes and MRFs across various socio-economic and demographic groups.</p> Results <p>From 2006 to 2016, diabetes was more prevalent among women, but from 2016 to 2021, men experienced a higher increase. Most MRFs exposure, such as abnormal BMI, alcohol, and tobacco use, decreased, except for a rise in low dietary diversity among women between 2016 and 2021. Older age, lower education, and poorer wealth were significantly linked to diabetes and MRFs in both genders. In 2016 and 2021, diabetic women had higher MRFs exposure, as did diabetic men in 2021. Men consistently showed higher MRFs exposure than women across all survey rounds. Higher education and wealth generally reduced MRFs exposure among diabetic patients.</p> Conclusions <p>The study reveals changing diabetes trends between genders in India, highlighting the need for tailored interventions. While some MRFs have decreased, rising dietary homogeneity among women is concerning. Socio-economic factors like education and wealth have protective effects. Targeted, gender-specific strategies are crucial for effectively managing India's diabetes burden.</p>