South Asia is home to nearly a quarter of the world’s population and is currently undergoing an epidemiological transition with an explosion in the prevalence of non-communicable diseases (NCDs) [1, 2]. India, the largest country in the region, is also the largest contributor to the NCD burden. Non-communicable disease (NCD) rates are rapidly increasing in India with wide regional variations. “Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional population-based study (ICMR-INDIAB-17)” by Ranjit Mohan Anjana et al. [3] recently published in Lancet Diabetes Endocrinol June 2023 assessed a representative sample of individuals aged 20 years and older, drawn from urban and rural areas of 31 states, union territories, and the National Capital Territory of India. The overall weighted prevalence of diabetes was 11.4%, prediabetes 15.3%, hypertension 35.5%, generalised obesity 28.6%, abdominal obesity 39.5%, and dyslipidaemia 81.2%. All metabolic NCDs except prediabetes were more frequent in urban than rural areas.

“Secular trends in the prevalence of diabetes and prediabetes among the rural population of South India” by Natarajan Lakshmi, V Mohan [4] published in this current issue aimed to assess the secular trends in the prevalence of diabetes and pre-diabetes from two cross-sectional studies done 11 years apart, in rural Tamil Nadu TREND Vs CRDPP. The prevalence of diabetes among adults in rural south India has dramatically increased, while that of prediabetes, has decreased over an 11-year period. The decrease in prevalence of prediabetes might suggest a future slowing down of the epidemic.

“Incidence and predictors of metabolic syndrome in Asian‑Indians: a 10‑year population‑based prospective cohort study” by Satyam Singh Jayant [5] published in a current issue prospectively evaluated a subset of Chandigarh Urban Diabetes Study cohort (n = 1023) without diabetes or metabolic syndrome over a mean of 10.7 years. Metabolic syndrome was defined as per International Diabetes Federation criteria and diabetes as per American Diabetes Association standards. The study concluded that Asian-Indians have a high incidence rate of metabolic syndrome, which is associated with sedentary lifestyle and consequent central obesity. Those with metabolic syndrome had a five-time higher risk of diabetes and a threefold higher risk of hypertension.

“Progression of prediabetes to diabetes and its associated factors”: The Fasa Adult Cohort Study (FACS) by Mehdi Sharafi [6] in the recent issue shows that the cumulative diabetes incidence was alarmingly high in Iran. Also, the co-occurrence of factors such as high fatty liver index (FLI), high DII score (dietary inflammatory index), metabolic syndrome, and waist-to-hip ratio increased the risk of diabetes in prediabetic individuals. These results point out the importance of applying effective preventive interventional programs for individuals with prediabetes.

“Circulatory levels of multiple microRNA associated with prediabetes study by Pratibha Misra” [7] in the current issue concluded that miR-15a-5p, miR-126-3p, and miR-192-5p in serum might be used as reliable, minimally invasive diagnostic biomarker to discriminate prediabetes from healthy individuals in addition to existing biomarkers. Future studies with larger number of subjects are needed to establish clinical utility of this panel.

“Utility of Indian diabetes risk score for the screening of type 2 diabetes mellitus and cardiovascular disease in and around areas of Lucknow”— A study by Mohd Danish Khan [8] published in this issue showed that the MDRF-IDRS is an efficient and cost-effective tool for the screening of abdominal obesity, T2DM and CVD. Presently, the MDRF-IDRS is validated and is an important tool for bulk screening of disease at an early stage in primary public healthcare centres to reduce the prevalence of T2DM, abdominal obesity and CVD and its associated morbidity and mortality.

“A multicentric, randomized, controlled trial of yoga and fenugreek in prevention of type 2 diabetes mellitus: methodological details—the Indian Prevention of Diabetes Study (IPDS)” by S. V. Madhu et al. [9] published in the current issue is a first of its kind to prospectively evaluate if yoga and fenugreek can prevent the composite outcome of T2DM in prediabetic individuals. It aimed to investigate whether there is an effective and safe treatment modality for the prevention of T2DM which is also cost-effective and can be implemented easily on a large scale so as to reduce the burden of T2DM. Patients with prediabetes already manifest abnormalities of glucose handling and could benefit from fenugreek, a low-risk, inexpensive, food-based intervention that could normalize their metabolic milieu. The data generated to date on the effects of yoga as well as fenugreek in the prevention of type 2 diabetes mellitus are sparse and well designed, adequately powered, randomized, clinical trials evaluating their effects in diabetes prevention would provide useful information.

A majority of people with prediabetes will eventually have diabetes, usually within 5 years. “The prevalence of prediabetes is increasing worldwide, and it is projected that 470 million people will have prediabetes by 2030. This is an impending tsunami, and it will be very taxing on the healthcare system.” An early intervention can reduce the incidence of complications associated with prediabetes, thereby reducing the cost of caring for the patients and improving their long-term quality of life. Primary care practitioners, who already provide 90% of care for prediabetes and diabetes, will play a critical role in trying to hold back the tsunami.

Insulin resistance and development of frank diabetes are preceded by a long period of glucose intolerance, and screening tests and tools like IDRS can identify patients at high risk of developing diabetes. During that time lag, potentially effective intervention can address multiple modifiable risk factors, including obesity, body fat distribution, physical inactivity, and high blood glucose.

Multiple studies conducted since the mid-1980s show that diet, exercise, other lifestyle modifications, and medication can reduce the risk of progression from prediabetes to diabetes by 25–72% during follow-up periods ranging from 2 to 6 years.

Missed opportunities for diabetes prevention can translate into clinical consequences for patients with prediabetes, hence, may add to a rising burden of NCD and diabetes. Early detection and intervention are vitally important for the prevention of prediabetes progression to diabetes and to help decrease micro and macrovascular complications.

Prediabetes is a serious independent health condition. Not only does it put you at an increased risk of developing type 2 diabetes, heart disease, and stroke, it’s a real, common and serious condition that sows the seeds for multiple complications and comorbidities. But most importantly, it’s reversible. You can prevent or delay prediabetes from progressing into type 2 diabetes with simple, proven lifestyle and behavioural changes aimed at weight loss, physical activity and good eating habits.