Type 2 diabetes mellitus (T2DM) is a worldwide epidemic and India has second largest burden of diabetes in the world. Microvascular complications, such as retinopathy, nephropathy and neuropathy, can occur at diagnosis and are evidence of years of unnoticed hyperglycaemia. Knowing the metabolic and microvascular burden at the first diagnosis is crucial for early targeted intervention.Methods: A cross sectional study was carried out by enrolling 300 drug naïve adults with newly diagnosed T2DM (A1C ? 6.5% at the time of diagnosis <6 months).Comprehensive glycaemic profiling (FPG, PPPG, HbA1c), fasting lipid profile, spot urinary albumin-creatinine ratio (ACR), fundus photography for diabetic retinopathy (DR), biothesiometry/10-g monofilament for peripheral neuropathy, and eGFR were performed. Patients were stratified by HbA1c: <8%, 8–9.9%, and ?10%.Results: Mean HbA1c was 9.4 ± 2.1%. Dyslipidaemia was present in 71.0% (hypertriglyceridaemia 48.0%, low HDL 56.0%). Any microvascular complication was detected in 36.7%: albuminuria 22.0%, retinopathy 14.0%, peripheral neuropathy 31.3%. The prevalence of all microvascular complications rose significantly with HbA1c ?10%. In multivariable analysis, HbA1c ?10%, central obesity (waist ?90 cm in men, ?80 cm in women), and hypertriglyceridaemia were independent predictors of microvascular complications.Conclusion: A substantial proportion of newly diagnosed T2DM patients already harbour microvascular complications, underscoring the 'ticking-clock' phenomenon of pre-diagnostic hyperglycaemia. Simultaneous metabolic and microvascular evaluation at the time of diagnosis and early multifactorial intervention are essential