Prediabetes in India: What Is It and Who's at Risk

Why is Prediabetes a Silent Crisis in India?

India already has one of the world’s highest diabetes burdens. Prediabetes sits right before that stage, often with no warning at all.

A 2024 HbA1c-based study of nearly 20 lakh adults across Indian states found that 22.25% of those tested had prediabetes, with substantial variation across regions [2]. A separate analysis of older adults (aged 45 and above) found prediabetes in 30.6% of participants, signalling a major public health concern [3].

The ICMR-INDIAB study found prediabetes prevalence as high as 14.6% in some states and noted that age, family history, abdominal obesity, hypertension, and income level were all significant risk factors for prediabetes in India [4].

What makes this worse: most people feel completely fine, even as their blood sugar creeps upward.

What are the Warning Signs of Prediabetes?

This is where most Indians get caught off guard. Prediabetes symptoms are rare. It has been noticed that 8 in 10 people with prediabetes do not know they have it [1].

Still, there are a few signs worth knowing:

Acanthosis Nigricans (Dark Patches on Skin)

One possible physical sign of prediabetes is darkened, velvety skin in areas like the neck, armpits, or groin. It is often described as one of the few outward signs that something may be off [5]. Many Indians dismiss this as a skin issue, not realising it may signal insulin resistance.

Early Signs That Blood Sugar Is Rising

When prediabetes starts to move toward type 2 diabetes, the body begins to show early signals:

• Needing to urinate often, especially at night, as the kidneys work overtime to clear excess sugar
• Feeling very thirsty even after drinking water throughout the day
• Feeling hungry again shortly after a full meal, as cells are not absorbing glucose properly
• Feeling tired or low on energy without a clear reason, even after enough sleep
• Blurred vision during certain parts of the day due to fluid changes in the eyes

These are not definitive prediabetes symptoms on their own. But together, they are a reason to have a blood sugar test.

The Real Warning Sign: No Warning At All

The most important thing to know about the warning signs of prediabetes is that, for most people, there are none. Usually, prediabetes has no symptoms or signs [5]. This is why regular screening matters, especially if you have any of the risk factors below. Blood sugar levels can remain above normal for years without causing noticeable health problems. During this time, however, insulin resistance may continue to worsen, increasing the risk of progressing to type 2 diabetes. Detecting prediabetes early through a simple blood test gives you the best chance to reverse it before long-term complications begin.

Also Read: Type 2 Diabetes in Children: Why More Indian Kids Are Developing It Early

Who is at Risk? Know Your Prediabetes Risk Factors

Prediabetes does not pick randomly. Certain patterns in your health, body, and family history put you at higher risk.

It is also noted that certain ethnicities, including South Asians, face a higher risk of developing prediabetes, making regular screening especially important in the Indian population [5].

How is Prediabetes Diagnosed?

Diagnosis is simple and requires only a blood test. There is no way to know from symptoms alone.

Fasting Blood Sugar Test

You fast for at least 8 hours (usually overnight) before the test. According to a study, a result between 100 and 125 mg/dL indicates prediabetes. A reading below 100 is normal; 126 or above is diabetes [1].

HbA1c Test

This test shows your average blood sugar over the past 2 to 3 months. Usually, HbA1c between 5.7% and 6.4% means prediabetes. Below 5.7% is normal; 6.5% or higher is diabetes [1].

If you are above 35, overweight, or have any of the risk factors listed above, speak to the right doctor or your nearest specialist about getting screened. A simple fasting blood test can catch prediabetes before any damage begins.

How to Reverse Prediabetes: Steps That Actually Work

What you need to understand is that prediabetes is not permanent. Healthy lifestyle changes, especially eating well and moving more, are the best way to treat prediabetes and prevent or delay type 2 diabetes.

1.   Lose a Little Weight

You do not need to reach your ideal weight overnight. Usually, losing just 7% of your body weight can cut the risk of developing type 2 diabetes by more than half [1]. For a person who weighs 80 kg, that is around 5.5 kg.

2.   Move More

Exercise makes your muscles more sensitive to insulin. It is usually recommended that 30 minutes of activity almost every day, for at least 150 minutes per week [6]. A brisk walk after meals counts. Even a 10- to 15-minute post-meal walk helps lower blood sugar.

3.   Manage Stress and Sleep

At times, even stress and lack of sleep also add to insulin resistance. Aim for 7 to 9 hours of sleep each night. Yoga, pranayama, and spending time outdoors are all practical stress-relief tools.

4.   Quit Smoking

Smoking is directly linked to higher insulin resistance and a greater risk of progressing to type 2 diabetes in people with prediabetes [5]. Stopping smoking is one of the most powerful actions you can take.

What Food Items Can You Eat?

There are certain foods you can eat to help prevent diabetes and keep your blood sugar levels low. Foods to eat: Dal, legumes (rajma, chana), jowar, bajra, ragi, brown rice, whole wheat roti, paneer, eggs, fish, leafy greens, nuts, seeds. Foods to limit: White rice, maida, packaged snacks, sugary drinks, mithai, fried foods, flavoured yoghurt

Note: A specialist or registered dietitian can help you personalise this plan based on your blood sugar readings and food habits.

What Happens If Prediabetes Is Left Untreated?

Ignoring prediabetes does not make it go away. Long-term damage, including your heart, blood vessels, and kidneys, may already be beginning even before prediabetes becomes type 2 diabetes [5].

Without action, prediabetes can progress to type 2 diabetes, which in turn raises the risk of:

• Heart attack and stroke
• Kidney disease and failure
• Nerve damage (numbness in hands and feet)
• Eye damage and loss of vision
• Slow-healing wounds and infections

Prediabetes increases the risk of heart attack and stroke even before it becomes full diabetes[1]. Early action is not optional; it is essential.

When to See a Doctor?

You must consult a doctor if you have any of the risk factors listed above, even if you feel perfectly fine. A simple fasting blood test is all it takes. If you are based in Kolkata, consulting the best diabetologist in Kolkata at Eskag Sanjeevani can help you get screened, understand your results, and build a plan to bring your blood sugar back to normal. Early detection makes reversal a lot easier.