Prediabetes rarely announces itself. There is no sudden fatigue and no dramatic symptom that forces a health check. An estimated 13.6 crore Indians are prediabetic, a number larger than the country’s diabetic population and one that is growing faster than expected.
Published Nov 14, 2025 | 6:00 AM ⚊ Updated Nov 14, 2025 | 6:00 AM
Representational image. Credit: iStock
Synopsis: India is facing a rapid surge in prediabetes, with more than 13.6 crore people already in the early metabolic risk stage. Experts warn that adolescents and working-age adults are increasingly affected; however, evidence shows that when action is taken without delay, lifestyle changes, supported by medical guidance where necessary, can significantly restore normal glucose control and prevent progression to diabetes.
As India marks another World Diabetes Day today, the country is at a critical turning point. The steep rise in diabetes has dominated public health conversations for years, yet the real opportunity lies in the stage that comes just before it.
Prediabetes, a condition in which blood sugar is elevated but not yet in the diabetic range, is now affecting crores of Indians quietly and steadily. Doctors say it is also the most reversible point in the entire metabolic journey.
“It is easier to reverse pre-diabetes and achieve a state of normal glucose metabolism than it is to reverse overt or full-blown diabetes. The reason being, prediabetes is an earlier stage in the natural history of type 2 diabetes and at this stage the pancreatic beta cell function is relatively well preserved and there are only minor defects in insulin secretion as well as insulin resistance,” explained Dr V Mohan, an internationally renowned endocrinologist and Chairman Dr V Mohan’s Diabetes and Research Centre, Chennai.
Prediabetes rarely announces itself. There is no sudden fatigue and no dramatic symptom that forces a health check. People continue with work, commute and family routines without realising that their body is already struggling to manage glucose.
It is the phase when fasting plasma glucose levels exceed 100 milligrams per decilitre but remain below 126 milligrams per decilitre.
“This is the stage where the body is signalling gently. It is not shouting yet,” said Dr Abhay G, endocrinologist at Sagar Hospitals in Bengaluru, in an earlier interview to South First.
He explained that the pancreas is still capable of recovery at this time. “If people act now, they can pull their numbers back. The body is very cooperative in the prediabetic phase,” he added.
A national analysis published earlier this year estimated that more than 13.6 crore Indians fall into the prediabetic category. This group is larger than the diabetic population and is growing faster than expected.
There is promising data as well. A multicentre Indian study observed that nearly half of prediabetic adults who underwent a structured lifestyle intervention reversed their condition within one year. Improvements were seen in fasting glucose, HbA1c, weight, insulin resistance and visceral fat.
Notably, adolescents are entering the risk spectrum too. National-level data show that more than ten percent of boys and nearly eight percent of girls aged between ten and nineteen fall in the prediabetes or diabetes bracket. Experts call this shift “the alarm before the alarm”.
Interestingly, MediBuddy, a healthcare booking app, in its recent corporate health screening data for India, has revealed a steady rise in the prevalence of prediabetes among corporate employees. Between August 2023 and July 2024, of the employees screened, 19.38 percent were prediabetic. From August 2024 to July 2025, the prevalence rose to 24.40 percent. The largest burden was seen in the age group of 31 to 50 years, with an increase also noted among younger adults aged 20 to 30 years.
Prediabetes is a physiological warning that still responds quickly to change. The pancreas is still producing insulin, insulin receptors are not fully resistant and cellular recovery is still possible.
Dr Abhay said that many of his patients see improvements within two to three months when they modify diet, improve sleep and increase physical activity.
“Once it becomes diabetes, the damage becomes harder to roll back. In the prediabetes stage, you can still turn the clock back without intense medical intervention,” he explained.
The rise of GLP-1 based drugs such as semaglutide and tirzepatide has changed public attention around metabolic health. Originally developed for diabetes, these medications help regulate appetite, reduce insulin resistance and improve glucose control.
Doctors say that people who are already diabetic benefit significantly from these drugs. They lose weight, reduce inflammation and bring blood markers under control.
However, they are not to be treated as the first resort. “GLP-1 drugs can be incredibly transformative for the right patient, but they are not the first step. Prediabetes should not be treated as a reason to jump onto medication. It is the stage where lifestyle still works beautifully,” Dr Abhay said.
Prediabetes can be reversed without drugs in a majority of cases if caught early. The medicines should be viewed as tools for high-risk individuals, not shortcuts for the general population.
However, if the person is overweight or obese, and with a doctor’s judgement, drugs like semaglutide or tirzepatide may be prescribed for weight loss, which in turn improves insulin sensitivity, explain doctors.
“Although GLP-1 drugs do not have formal approval specifically for prediabetes and are labelled for diabetes management, they are approved for weight loss in non-diabetics,” Dr V Mohan explained.
“Since obesity is directly linked to the risk of diabetes, there is no harm in using these medications in people with diabetes, as well as those who are obese but not diabetic, when the goal is to prevent progression to diabetes. This should be done only under medical advice.”
India cannot afford to wait until diabetes takes hold. The country has enough scientific evidence to show that prediabetes is not only detectable but highly reversible.
As Dr Abhay put it: “This is the moment where the narrative can change. Once it progresses to diabetes, you spend a lifetime managing it. In prediabetes, you still have the freedom to choose a different outcome.”
Experts argue that India is approaching a point where inaction will cost more than intervention. Health economists say the burden of untreated prediabetes will translate into higher rates of kidney failure, heart disease, stroke and lost productivity within the next decade. Doctors are also seeing prediabetes in teenagers and young adults, which was rare even a few years ago.
India has the expertise, the diagnostic capacity and the tools required to intervene early. What it does not have is time.
For crores of Indians who may not know they are already on the borderline, early testing and timely action could decide whether the next decade is spent fighting a lifelong illness or reclaiming full metabolic health.
Dr V Mohan explains that people can reverse prediabetes with diet, exercise and weight reduction.
“People can reverse prediabetes with simple changes in diet, exercise and weight reduction. In several studies, even without major weight loss, individuals who improved their diet, increased physical activity and practised yoga, pranayama and meditation showed clear reversal of prediabetes,” he said.
“Better stress management and adequate sleep also make a significant difference. We demonstrated this in the D-CLIP study conducted at our centre, along with findings from other research.”
Experts also suggest the following steps:
(Edited by Dese Gowda)
