The Lancet Diabetes & Endocrinology, 2023
India has more adults living with prediabetes than with diabetes. The ICMR-INDIAB study, the largest nationally representative survey of metabolic disease in India, found diabetes in 11.4% of adults and prediabetes in a further 15.3% — meaning the group standing at the threshold is larger than the group already diagnosed. Separately, an analysis of NFHS-4 data found that 42% of Indians whose blood sugar was already elevated did not know it, with younger adults and men least likely to be aware. Read together, these two findings describe the central problem in Indian preventive health: the disease is common, it is detectable, and the detection is not happening. Prediabetes is also the stage at which the trajectory is most readily changed, which is what makes the size of that group the more consequential number of the two.
ICMR-INDIAB, published in The Lancet Diabetes & Endocrinology in 2023, surveyed adults across every Indian state and union territory. It found a national diabetes prevalence of 11.4% and prediabetes prevalence of 15.3%.
The ratio is the finding that matters. In most disease models the diagnosed group is the large one and the at-risk group is a narrower band ahead of it. Here it is inverted: for every ten adults with diabetes there are roughly thirteen more with prediabetes, a stage at which progression is frequently preventable.
An analysis of National Family Health Survey (NFHS-4) data published in BMJ Open Diabetes Research & Care found that 42% of Indians with already-elevated blood sugar were unaware of it. Awareness was lowest among younger adults and among men.
The mechanism is not mysterious. Early metabolic dysfunction produces no symptoms a person would take to a doctor — an afternoon energy dip, weight gathering at the waist, sleep that stops being restorative. None of these prompt a blood test, and standard checkup packages measure glucose only after the compensating phase has already been running for years.
Less than it should, on the current evidence. ICMR-INDIAB-13 found that only about 7% of Indians already diagnosed with diabetes were simultaneously meeting their glucose, blood-pressure and lipid targets.
That figure reframes the problem. Diagnosis is a necessary step, not a sufficient one, and the gap between being diagnosed and being adequately cared for is wide enough that it deserves as much attention as the undiagnosed group.
Frequently, yes. Prediabetes describes a stage of insulin resistance in which glucose regulation is impaired but not yet failed, and structured changes to diet, activity, visceral fat and sleep can return many people to normal glucose tolerance. The likelihood of reversal falls the longer the stage persists, which is the argument for detecting it early.
Fasting insulin and HOMA-IR move years before fasting glucose or HbA1c, because the body maintains normal glucose by producing progressively more insulin. Glucose-based tests, which are what standard checkups measure, only register once that compensation begins to fail.
81.2% — The Lancet Diabetes & Endocrinology, 2023
53.4% — The Lancet Global Health, 2018
The programme
Peak Brain draws a full blood and urine panel at your home, has a licensed physician read every marker together rather than one at a time, and turns what they find into a ranked 90-day protocol with a retest at the end.
Authorship & review
Written by the Peak Brain clinical team. Assigned clinical reviewer: Dr. Alfia Kaki, MD, PGC — review pending; this page has not yet been signed off.
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