Background Diabetes is progressively becoming a vital chronic disease burden worldwide, mainly in developing countries such as India; this necessitates a shift in healthcare priorities and advanced data on the epidemiology and impact of diabetes to help plan and prioritize health programs. We systematically reviewed the literature on diabetes prevalence and its complications in India. Methods This systematic review focuses on diabetes prevalence and complications in India from January 2000 to September 2021. Literature searches were conducted using electronic databases. Results Diabetes prevalence ranged from 2.02% in rural Madhya Pradesh to 40.3% in Tamil Nadu. Diabetes prevalence was significantly higher in urban areas than in rural areas. The prevalence of pre-diabetes varied across Indian states ranging from 2.4% in Meghalaya to 47.6% in Delhi. The prevalence of chronic diabetes complications ranged from 4.8–21.7% for retinopathy, 0.9–62.3%% for nephropathy, and 10.5–44.9% for neuropathy. Conclusions Diabetes is a significant and widespread health problem in India. Dissimilarity in the prevalence of diabetes between individual states is observed. Most diabetes patients experience chronic complications of diabetes. Consequently, it is essential to map the urgent preventive approach to reduce the further increase in areas with high prevalence.