Background: Individuals with diabetes mellitus and pre-diabetes are at particularly high risk of incident heart failure (HF) or death, even after accounting for known confounders. Prior studies have shown that individuals with diabetes have increased left ventricular (LV) wall thickness and mass, and impaired diastolic function in the absence of overt LV systolic dysfunction; the alterations in cardiac structure and function in less impaired glycemic states without prevalent cardiovascular disease are less well described. Also most previous studies have only performed limited measures of cardiac structure and function, and none have comprehensively evaluated cardiac parameters, particularly diastolic function. Aim: This study was done with the aim of studying the cardiac structure and functions in normotensive patients with prediabetes and diabetes who don’t have symptoms of heart failure. Method: The study was an analytical cross sectional study with a comparison group. The study was conducted in department of Medicine which caters to more than 11000 in patients annually out of which at least 4-5% are suffering from diabetes mellitus. We estimated number of diabetic patients as 30, prediabetics as 130 and normal patients in the comparison group were estimated to be 130. All consecutive patients who was known case of diabetes mellitus or on anti-diabetic medication are followed up regularly in out-patient (OPD) of medicine department and worked up and managed according to American diabetes association (ADA) standards of care for patients with diabetes mellitus. All patients included in the study was subjected to 2D echocardiography. An echocardiography examination, including M-mode, two dimensional (2D) and Left ventricular mass and left ventricular mass indexed to body surface area estimated by LV cavity dimension and wall thickness at end-diastole. Results: We enrolled a total of 300 study participants out of which 40 diabetics, 130 prediabetes and 130 normal individuals which were used as a comparator group for both diabetic patients and prediabetes patients. The mean age of our study participants was 54.85 ± 13.65 in diabetes, 53.72 ± 12.18 in prediabetes and 49.49 ± 11.88 in the comparator group. The diabetic patients showed significantly increased LA volume in prediabetes (38.27 ± 8.74) and diabetes patients (34.26 ±10.82) as compared to the normal (27.47 ± 8.81). The dimensions of LV interventricular septum in systole and diastole were increased in diabetic and prediabetes patients as compared to normal individuals. Similarly, the EDV was significantly higher in diabetic and prediabetes patients. The LVEF was reduced significantly in the diabetic (50.26 ±5.41) and prediabetes (52.43 ±4.69) as compared to the normal individuals. The E/A ratio was increased in diabetic patients (0.78±0.10) and prediabetics (0.84±0.09) as compared to normal individuals. LV mass was also more in the diabetic and prediabetic patients. Discussion: We demonstrated several indices of LV systolic and diastolic dysfunction were increased in both diabetes and prediabetes, LV geometry differed significantly and decrease ejection fraction, increase LV mass in prediabetes and diabetes as compared to comparator group. We have performed robust characterization of cardiac structure and function beyond ejection fraction and LV mass and looked at LA volume indices.