Are you at risk of prediabetes? Know the symptoms, and risk factors

Prediabetes may have no clear symptoms, but early detection and small lifestyle changes can help reverse the risk

India has more than 101 million people living with diabetes and 136 million with prediabetes, according to the Indian Council of Medical Research – India Diabetes (ICMR-INDIAB) study published in 2023. These staggering numbers surpass the population of many nations and highlight the urgent need for awareness and early action. Prediabetes is a silent health condition that often goes unnoticed until it progresses into type-2 diabetes. The good news is that with timely diagnosis, lifestyle changes, and proper awareness, prediabetes can often be reversed.

 

How is prediabetes different from type-2 diabetes? 

Prediabetes means your blood sugar levels are higher than normal but not yet high enough to be classified as type-2 diabetes. Think of it as a warning sign or a “pre-stage” that gives you a chance to make changes before diabetes sets in. Unlike type-2 diabetes, prediabetes can be managed and even reversed through early intervention.

 

 

“One is diabetic if fasting blood glucose is ≥126 mg/dL or HbA1c ≥6.5 per cent. In prediabetes, the fasting plasma glucose is typically between 100 to 125 mg/dL, HbA1c 5.7–6.4  per cent, or postprandial glucose (following an oral glucose tolerance test) is 140–199 mg/dL,” shared Dr Manisha Arora, director of internal medicine at CK Birla Hospital, New Delhi.

 

Warning signs of prediabetes 

One of the biggest challenges with prediabetes is that it often has no obvious symptoms.

However, some early warning signs may include:

• Increased thirst
• Frequent urination
• Fatigue, being tired in the mornings
• Blurred vision
• Darkened skin in your armpit, back or sides of your neck (acanthosis nigricans)
• Skin tags

 

Who is more at risk of prediabetes? 

Certain groups are more vulnerable to prediabetes.

• Overweight or obese patients (BMI ≥25 kg/m²; ≥23 for Indians)
• Those with a family history of diabetes are more vulnerable
• People who are physically inactive
• People with high blood pressure
• People with an established disorder of cholesterol
• Pregnant women with gestational diabetes or
• Individuals with PCOS (polycystic ovary syndrome)

 

“Prediabetes is largely brought about by insulin resistance and failure of beta cells, with further complicity by being obese, most classically central obesity. Ineffective weight loss habits (diet high in refined or packaged foods), lack of exercise, and sleep deprivation contribute their share as well. Medicinal causes comprise non-alcoholic fatty liver disease (NAFLD), metabolic syndrome, and chronic usage of steroidal medication,” explained Dr Jatin Kumar Majhi, consultant endocrinologist and diabetologist, Manipal Hospital, Bhubaneswar.

 

Age factor comes into play as well as risk increases with age. “South Asians and Indians in general are also genetically predisposed to insulin resistance and therefore more prone than most other groups,” said Dr Arora.

 

Lifestyle elements that add to the risk

 

Contemporary sedentary lifestyle is one of the primary reasons for the increase in prediabetes cases, according to experts.

• Sedentary lifestyle
• Prolonged sitting
• Poor-quality diets with overuse of refined carbohydrates, sweet drinks, processed foods
• Disturbed sleep patterns leading to inadequate rest
• Chronic stress, increased cortisol levels

 

Diagnosis and tests for prediabetes 

Fasting Plasma Glucose (FPG) - Measures blood sugar after at least 8 hours of fasting

Approx cost: ₹150–₹300 

Oral Glucose Tolerance Test (OGTT – 2 hour value) - Measures blood sugar 2 hours after drinking a glucose solution

Approx cost: ₹400–₹800 (varies if 1-hour reading is also included) 

Haemoglobin A1c (HbA1c): Reflects average blood sugar over the past 2–3 months

Approx cost: ₹300–₹800 (most labs charge ₹300–₹500)

 

Experts recommend that adults over 45, or those with risk factors like obesity and family history, get tested regularly. Early testing can make all the difference. “If left untreated, 5–10 per cent of people with prediabetes will develop diabetes every year. Heart disease, kidney disease, nerve disease, and eye disease risk is also elevated even before diabetes is present. Ignoring prediabetes also worsens metabolic syndrome, with further risk for death,” cautioned Dr Majhi.

 

Managing prediabetes 

The encouraging news is that prediabetes can be reversed or controlled with early intervention, shared Dr Arora.

“Weight loss is the best approach; even losing 7–10 per cent of body weight lowers the risk of getting diabetes considerably. Yoga, meditation, or any other relaxation method also controls stress. Adoption of a healthy diet with whole grains, vegetables, fruits, and lean proteins, and decreased consumption of processed and high-sugar foods is crucial,” she recommended.

 

Metformin is often recommended for people at higher risk of developing type-2 diabetes, explains Dr Majhi. High-risk patients include those with severe obesity (BMI ≥35), individuals younger than 60, women with a history of gestational diabetes, and people whose HbA1c levels continue to rise despite lifestyle changes.

 

Importance of early detection 

“Screening early among high-risk people enables early modification of behaviour before extensive damage to cells that make insulin,” said Dr Majhi.

 

Dr Arora adds that if diagnosed at the prediabetes level, one can escape it by implementing measures through lifestyle change and medical treatment, and hence escape from the onset of diabetes and complications. “At a mass level, community-level awareness programmes, preventive screening, and education towards healthy lifestyles can prevent the increasing health and economic burden of diabetes, not only in India but worldwide,” said Dr Arora.