Prediabetes: what to do next

Reviewed by the JForH team · 2026-10-30

Under ICMR's 2018 guideline, prediabetes is a fasting sugar of 110–125 mg/dL, a 2-hour glucose tolerance result of 140–199 mg/dL, or an HbA1c of 5.7–6.4%. It is common: about 136 million Indians have it. In the Indian Diabetes Prevention Programme, lifestyle changes cut the risk of diabetes over three years by 28.5%. Retest every year, and start with food portions, activity and weight.

What is prediabetes?

Prediabetes means your sugar is higher than normal but not yet in the diabetes range. ICMR's 2018 guideline uses these cut-offs:

Doctors also call these impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Some people call it borderline diabetes.

My fasting sugar is 110 to 125. Do I have diabetes?

Not by ICMR's numbers. A fasting 110–125 mg/dL is prediabetes. Diabetes starts at 126, and ICMR asks for a high result to be confirmed with a second test.

You may see a different number on American websites. The American Diabetes Association starts prediabetes at a fasting 100 mg/dL, not 110. So a fasting 105 is normal by ICMR and prediabetes by ADA. If yours sits between 100 and 109, it's still a good time to act.

How common is prediabetes in India?

Very. The ICMR-INDIAB study, published in 2023, estimated about 136 million Indians have prediabetes, 15.3% of adults. That's more than the roughly 101 million who already have diabetes.

Who should get tested, and from what age?

ICMR says everyone over 30 should be screened, because type 2 diabetes starts at least a decade earlier in Indians than in many other groups. Test earlier if you have any of these:

• a parent, brother or sister with diabetes
• BMI of 23 or more, or a waist over 90 cm for men or 80 cm for women
• blood pressure of 130/80 or more, or on BP tablets
• high cholesterol or triglycerides
• little physical activity
• diabetes in pregnancy, or a baby over 3.5 kg at birth
• heart disease or a stroke
• PCOS, or dark velvety skin on the neck (acanthosis nigricans)

If your result is normal, ICMR says retest after 3 years. If you have prediabetes, retest every year.

Which test should I ask for?

Any of the standard tests will do. ICMR says screening can use a fasting plasma glucose, a 75 g oral glucose tolerance test or a random glucose. HbA1c is also recommended, but ICMR notes it has some limits in India.

A glucose tolerance test picks up people whose fasting sugar is normal but whose sugar stays high after food. If your random sugar is 140–199 mg/dL, ICMR advises this test. Have it done at a lab, not on a home glucometer.

Can prediabetes be reversed?

Often it can be held back, and sometimes sugar returns to normal. The best Indian evidence comes from the Indian Diabetes Prevention Programme, a trial in 531 adults with impaired glucose tolerance, published in 2006:

Lifestyle changes cut the risk by 28.5%, and metformin by 26.4%. Using both added nothing extra. For every 6 or 7 people who made the changes, one case of diabetes was prevented.

Prediabetes reverse kaise kare? What should I do now?

Start with the steps that changed results in trials and in Indian diet data:

1. Eat less carbohydrate overall. A 2025 ICMR-INDIAB study in Nature Medicine found about 62% of Indian calories come from carbohydrate, mostly white rice or wheat.
2. Swap some carbohydrate for protein. In the same study, replacing 5% of carbohydrate calories with plant or dairy protein was linked to lower risk. Think more dal, chana, rajma, paneer, curd or eggs, and a smaller heap of rice.
3. Don't rely on flour swaps alone. Switching refined cereal for whole wheat or millet flour, at the same amount, was not linked to lower risk in that study.
4. Move for about 150 minutes a week, with strength work twice a week. This is ICMR's advice for people with diabetes and suits prediabetes too.
5. Lose some weight if your BMI is 23 or more, or your waist is over the limits above.
6. Skip fruit juice and sugary drinks. ICMR says all fruit juices are best avoided. Have whole fruit such as guava, papaya or an orange in moderate amounts.
7. Stop smoking and chewing tobacco.

What does a prediabetes-friendly Indian plate look like?

Here's a simple swap. A lunch of 3 rotis with a small bowl of dal becomes 2 rotis, a full bowl of dal, a bowl of sabzi and a katori of curd. In the South, a plate heaped with rice and sambar becomes half the rice, more sambar with dal, a vegetable poriyal and curd.

Do I need metformin for prediabetes?

Not always. In the Indian trial, metformin worked about as well as lifestyle changes, and adding it to lifestyle changes gave no extra benefit. Your doctor may suggest it if your numbers are close to diabetes or lifestyle changes aren't possible for you. It's their decision with you, not a must.

How often should I recheck my sugar?

Once a year, says ICMR, with the same test each time if you can. Retest sooner if you develop thirst, frequent urination or weight loss without trying.

This guide is for education and does not replace advice from your own doctor.

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Last updated: 2026-10-30. Educational information, not medical advice. Talk to your doctor before changing your treatment.