Prediabetes in India: What Your HbA1c Number Means and How to Bring It Down

A lot of people in India find out they have prediabetes by accident. A routine office health check, a pre-surgery blood test, or a parent's diagnosis that pushes the whole family to get tested. The report says HbA1c 5.9%, the doctor says "borderline, watch your diet," and that's about it.

That word "borderline" makes it sound harmless. It isn't a diagnosis to panic over, but it is the most useful warning your body will give you. This post explains what the numbers mean, why Indians tip into diabetes earlier than many other groups, and what has actually been shown to help.

How common is prediabetes in India?

Very. The ICMR-INDIAB study, published in The Lancet Diabetes & Endocrinology in 2023, estimated that around 11% of Indian adults have diabetes and about 15% have prediabetes. That works out to well over 100 million people in the prediabetes range, and most of them don't know it.

The worrying part is how early it shows up. It's no longer something that starts at 55. Plenty of people in their late 20s and 30s, especially those with desk jobs and a family history, are already in this range.

What the numbers on your report mean

There are three common tests. Your doctor may use one or more of them.

TestNormalPrediabetesDiabetes rangeHbA1cBelow 5.7%5.7% to 6.4%6.5% or higherFasting blood sugarBelow 100 mg/dL100 to 125 mg/dL126 mg/dL or higher2-hour glucose (OGTT)Below 140 mg/dL140 to 199 mg/dL200 mg/dL or higher

These are the cut-offs commonly used by the American Diabetes Association and followed by many Indian labs. A diabetes diagnosis usually needs a repeat test to confirm, so one high reading on its own isn't the final word.

HbA1c is the one most people get now because you don't need to fast. It reflects your average blood sugar over roughly the past two to three months, which is why it's useful: one heavy dinner won't move it much.

A catch with HbA1c that matters in India

HbA1c measures sugar stuck to haemoglobin in your red blood cells. So anything that changes your red blood cells can throw it off. Iron deficiency anaemia, which is very common in Indian women, can push HbA1c slightly higher than your real sugar levels. Some other conditions, like certain haemoglobin variants, recent blood loss or kidney disease, can make it read lower or less reliably.

If your HbA1c and fasting sugar don't seem to agree, or you know you're anaemic, it's worth asking your doctor whether a fasting glucose or an OGTT would give a clearer picture.

Why Indians get there sooner

Researchers sometimes call it the "thin-fat Indian" pattern. Many South Asians carry more fat around the belly and inside the abdomen, and less muscle, even at a body weight that looks normal. That kind of fat is closely linked to insulin resistance.

Because of this, Indian guidelines use tighter limits than Western ones:

• A BMI of 23 or more is considered overweight for Asian Indians (versus 25 in many Western charts).

• A waist size above about 90 cm (35.5 inches) for men or 80 cm (31.5 inches) for women is seen as a risk marker.

Add a diet heavy in refined carbs, long sitting hours, poor sleep and a strong family history, and it's easy to see why the numbers creep up early. We've written more about the after-meal side of this in why you crash after rice and roti.

Who should get tested

You don't need to wait for symptoms. Prediabetes usually has none. It's sensible to talk to your doctor about a test if you:

• Are over 30 to 35 and have never checked

• Have a parent or sibling with type 2 diabetes

• Carry extra weight around the waist, even if your overall weight looks fine

• Have high blood pressure, high triglycerides or low HDL cholesterol

• Had diabetes during pregnancy, or have PCOS

• Have fatty liver on an ultrasound

The good news: this stage can often be turned around

Prediabetes is not a one-way street. Two big studies are worth knowing about.

The Diabetes Prevention Program in the US found that people who lost around 7% of their body weight and did about 150 minutes of brisk activity a week cut their risk of developing diabetes by 58% over about three years. That was better than the medicine group.

The Indian Diabetes Prevention Programme, run in Chennai, looked at Indians specifically. Lifestyle changes alone lowered the risk by roughly 28 to 29% over three years. Smaller than the US result, partly because many participants weren't very overweight to begin with, but still a meaningful drop from simple, low-cost changes.

What actually helps, in practical terms

1. Lose a little weight, mainly from the belly

You don't need a dramatic transformation. Losing 5 to 7% of your body weight is the range most studies point to. For someone at 80 kg, that's 4 to 6 kg. Watch your waist measurement, not just the scale.

2. Change the plate, not the cuisine

You don't have to give up Indian food. A few swaps go a long way:

• Fill half the plate with sabzi or salad, a quarter with dal, paneer, eggs, chicken or fish, and a quarter with roti or rice.

• Eat the vegetables and protein first and the rice or roti last. Some studies suggest this order may soften the sugar spike after a meal.

• Cut back on sweetened chai, packaged juices, biscuits and namkeen. These add up quietly.

• Choose whole grains and millets where you can, but remember portion size still matters. A large bowl of millet is still a large bowl of carbs.

3. Move after meals

Aim for about 150 minutes of brisk walking or similar activity a week. Even a 10 to 15 minute walk after lunch and dinner may help bring post-meal sugar down. If you're starting from zero, our post on how many steps you need with a desk job is a good place to begin.

4. Build some muscle

Muscle is where a lot of your blood sugar goes after a meal. Two or three sessions of strength training a week, even bodyweight work at home, can improve how your body handles glucose. See our beginner's home strength plan.

5. Sleep and stress count too

Short sleep and constant stress both make insulin work less well. Regularly sleeping five hours and running on caffeine is not a neutral habit when your sugar is already borderline.

What about supplements and home remedies?

You'll find plenty of claims about methi seeds, cinnamon, karela juice, jamun and various "sugar control" powders. Some of these have small studies suggesting a modest effect, but the evidence is mixed and none of them come close to what weight loss and activity can do. If you want to try one, tell your doctor first, especially if you're already on medicine, because combining them can push sugar too low.

No supplement, including anything we sell, treats or reverses prediabetes. The basics above are where the real results come from.

Will I need medicine?

Not always. Many people with prediabetes are managed with lifestyle changes and regular checks. In some cases, for example if your numbers are close to the diabetes range, you have several other risk factors, or lifestyle changes haven't worked, a doctor may suggest medication such as metformin. That's a decision to make with your doctor, not something to start or avoid on your own.

How often to recheck

If you're in the prediabetes range, a common approach is to repeat the test about once a year, or sooner if your doctor advises it. Many people find it motivating to recheck HbA1c three months after making changes, since that's roughly how long the test looks back.

The short version

• HbA1c of 5.7 to 6.4% or fasting sugar of 100 to 125 mg/dL usually means prediabetes.

• Indians tend to reach this stage earlier and at lower body weights.

• Modest weight loss, regular walking, some strength training and a better-balanced plate can lower the chance of it becoming diabetes.

• Get tested if you have risk factors, and recheck regularly.

Disclaimer: This article is for general information only and is not medical advice. It does not replace a consultation with a qualified doctor. If you have prediabetes, diabetes or any other health condition, are pregnant, or take regular medication, speak to your doctor before changing your diet, exercise routine or supplements.