The prevalence of diabetes in India is rising rapidly, which results in substantial economic burden and productivity loss. Diabetes devices including continuous glucose monitors (CGMs), insulin pumps, and smart insulin pens, are critical for effective diabetes management. However, they remain underutilized due to high out-of-pocket expenditures, limited insurance coverage, and regional disparities in healthcare access. This paper highlights the need for economic evaluation of diabetes management devices in the Indian healthcare setting to improve accessibility and health outcomes. This paper also provides actionable insights for strengthening health technology assessment guidance for diabetes devices such as the need to establish real-world evidence (RWE) registries, incentivize local manufacturing, and integrate cost-effectiveness assessment into national/state health policy programs to improve access. We also provide guidance for future research to strengthen public-private partnership and incorporation of equity considerations in policy development. Strengthening economic evaluation is essential to achieve sustainable diabetes care in India.