Prevalence and factors associated with prediabetes among older adults in India: evidence from a national survey

Background Prediabetes is a reversible intermediate stage of dysglycemia that substantially increases the risk of diabetes and cardiovascular disease. India is witnessing a rapid rise in the burden of prediabetes; however, national evidence on biomarker-verified prediabetes among older adults remains limited. The present study aimed to estimate the prevalence of prediabetes and identify its associated factors among older adults in India. Methods We conducted a secondary cross-sectional analysis of wave one longitudinal aging study in India (LASI) data, a nationally representative survey of adults aged ≥45 years. A total of 58,386 participants with valid biomarker data on blood glucose levels were included. Prediabetes was defined as HbA1c 5.7–6.4%. Factors associated with prediabetes were examined using Poisson regression models to estimate adjusted prevalence ratios (aPRs) and 95% CIs. Results The weighted prevalence of prediabetes among adults aged ≥45 years was 30.4% (95% CI: 29.5–31.2), and dysglycemia (prediabetes + diabetes) was 49.8% (95% CI: 48.9–50.7). Factors independently associated with higher prediabetes prevalence were age 60–74 years (aPR 1.22, 95% CI 1.15–1.29), ≥75 years (aPR 1.30, 95% CI 1.16–1.45), female sex (aPR 1.12, 95% CI 1.06–1.19), not currently working (aPR 1.08, 95% CI 1.02–1.15), other religions versus Hindu (aPR 1.12, 95% CI 1.02–1.22), no acute anemia in the past 2 years (aPR 1.12, 95% CI 1.02–1.22), overweight (aPR 1.56, 95% CI 1.41–1.73), and obesity (aPR 1.90, 95% CI 1.70–2.13). Prediabetes was most prevalent in Telangana (70.0%) and lowest in Sikkim (6.6%), while dysglycemia was highest in Telangana (78.0%), and lowest in Meghalaya (16.7%). Higher dysglycemia prevalence was independently associated with older age (60–74 and ≥75 years), urban residence, not currently working, family history of diabetes, hypertension, and excess adiposity, with the strongest associations observed for overweight (aPR 1.65, 95% CI 1.53–1.78) and obesity (aPR 1.86, 95% CI 1.72–2.02) (all p < 0.001). Conclusion Prediabetes affects more than one in four older adults in India. The marked regional and socioeconomic disparities underscore the urgent need for population-specific, biomarker-based screening and prevention strategies targeting older adults to curb progression to diabetes and related complications.