Background: Prediabetes is a condition of intermediate hyperglycaemia in which blood glucose levels are high, but not more than the required diagnostic criteria to be labelled as Diabetes Mellitus. Now, there is a growing evidence regarding occurrence of peripheral neuropathy as well as cardiovascular autonomic neuropathy even in pre-diabetics. Aim: To determine nerve conduction abnormalities and cardiovascular autonomic dysfunction in pre-diabetics. Material and Methods: Total 100 subjects were divided into two groups of 50 each i.e. cases and controls, according to the ADA Criteria. Nerve conduction studies and Ewing’s cardiovascular autonomic reflex tests (CARTs) were performed on all the subjects. Results: On comparing the changes in the nerve conduction studies of the pre-diabetic subjects with the controls, statistically significant difference was found in the conduction velocity of the B/L peroneal nerve. Similarly, difference in the amplitude of the B/L tibial nerve was also found to be statistically significant. Cardiovascular autonomic neuropathy was found in 18 % of the pre-diabetic subjects. Conclusion: Neuropathy is often associated with long standing diabetes mellitus but neuropathy can occur even in pre-diabetics. Although full blown neuropathy is not present but the nerve damage has already started at the prediabetic stage, which is reflected upon by the nerve conduction abnormalities and cardiovascular autonomic dysfunction.