If anyone in your life has been after you for months to get a blood test, and you've successfully held them off saying "I'm fine," this one is for you.

The fact is, feeling fine doesn't tell you much about your blood sugar.

Loop Health, a group health insurance broker and employee-benefits platform, just released its Workforce Health Index 2026.

It's Loop's largest assessment of urban workforce health to date, covering insured employees and their family members.

These are people covered through Loop, not a representative sample of India's workforce, and the lab reports, survey responses and hospital claims are three separate datasets.

This one is based on actual lab results. So like always, I went through the whole report.

Among employee reports with an HbA1c on record, 31.3% had levels the report flags as dysfunctional, meaning at or above 5.7%.

(You may see 38.7% in the headlines. That figure counts employees and their family members together, so I'm sticking with the employee number.)

More than half of the HbA1c reports from people aged 40-49 were above the normal range.

Mumbai had the highest rate of the five cities at 46.8%. Bengaluru had the lowest, and even that was 30.7%. (The city figures include family members.)

Across employees and covered family members, 25.4% of HbA1c reports were in the prediabetes range and 13.3% in the diabetes range.

Those are just test results. The lab reports aren't linked to the survey responses, so the report can't tell us how many people were unaware of their result.

Elevated results were already common in the thirties: 33.0% of HbA1c reports in that age group were above the normal range, counting employees and covered family members together.

And prediabetes can go years without clear symptoms. Feeling fine doesn't rule it out. The only way to find out is to test.

Doctors have known for years that diabetes arrives early in South Asians. What surprised me was how big the gap was once someone measured it.

A 2011 study in Diabetes Care looked at adults in Ontario, Canada, by ethnicity.

South Asians were diagnosed at a median age of 49. White participants were diagnosed at 58, almost a decade later.

The same researchers also worked out the BMI at which each group reached the same diabetes risk. For white participants it was 30. For South Asians it was 24, a number most of us would look at and call perfectly normal.

PS: One number from the report I'd read carefully. 81.4% of Vitamin D reports were below its 30 ng/mL comparison cutoff. Use a cutoff of 20 ng/mL and the share drops to 60.1%.

And in 2024, the Endocrine Society advised against routine Vitamin D testing in healthy adults anyway.

Only 24.3% of the 7,048 responses to the healthcare question reported a full-body blood test in the past year.

41.5% reported none of the five listed activities: routine check-ups, doctor visits for symptoms or illness, full-body tests, workplace health camps and fitness assessments.

Testing varied with reported annual income. 15.6% of responses in the under-₹3 lakh band reported a full-body test, against 54.3% in the ₹40 lakh-and-above band.

Even in the highest-income band, 45.7% of responses did not report a full-body test in the previous year.

That doesn't tell us whether those respondents had a separate blood sugar test or needed a full-body panel.

It's easy to understand someone skipping a test to save money. It's much harder to explain the person who can easily afford it and still lets another year go by.

Most of us don't book a screening until something forces it, like a health camp at work or a parent's diagnosis. In most years, nothing does.

And no app or home collection service can create that push for you.

In 2013, the economist Emily Oster and two neurologists, Ira Shoulson and Ray Dorsey, studied people at risk of Huntington's disease. It's inherited, and a genetic test can confirm it long before any symptoms appear.

The test was cheap and close to perfectly accurate, yet very few people took it.

The ones who stayed untested tended to be more optimistic about their own health. As if not knowing was what let them keep hoping.

With Huntington's, I can understand that choice. There is no cure, although knowing can help someone plan their care and make family decisions.

Blood sugar is different.

Participants with sedentary routines were regularly encouraged to walk briskly for at least thirty minutes a day.

But first, a test had to tell them where they stood.

Doctors use the word borderline a lot, and I understand why. It's gentle and doesn't scare anyone out of the room.

For blood sugar, it can mean a result above the normal range but below the diabetes threshold. It doesn't, by itself, tell you whether the number has been rising.

I've written before about my father hearing that word from his doctor. He bought a treadmill, and for most of the year it held my mother's sarees.

He only started walking every morning once standing on it while the chai boiled had turned into a habit. None of that would have started without the test.

The test gave him a blood sugar result to work with.

The lab reports in Loop's study give us numbers from people who went for a checkup. They don't tell us what is happening among people who weren't tested.

That's the group I worry about.

So the next time someone brings it up, maybe don't say "I'm fine."

You might be. But feeling fine doesn't rule out raised blood sugar. Ask your doctor whether your age, family history or other risk factors mean it's time for a blood sugar test.

Hit reply and tell me: what finally made you, or your parents, get a blood test done when nobody was unwell?

I read every email.

Until next week,
Ritesh