One-third of people with pre-diabetic condition progress to type 2 diabetes within five years. However, with adequate knowledge on diabetes risk reduction behaviors, progression to diabetes can be controlled. We therefore recruited 220 suspected cases of pre-diabetic patients at Busia County Referral Hospital assessed their knowledge, and adaption of risk reduction behavior. A cross-sectional study design and a systematic sampling approach were used. The findings show that at the time of examination, only 42.7% (n=94) of the respondents were pre-diabetic, 38.6% (n=85) were diabetic and the rest had normal glucose level. Furthermore, only 66.8 % (n=147) and 28.1% (n= 61) had normal blood pressure reading and BMI status respectively. The majority of the respondents 60% (n=74) thought pre diabetes was caused by being overweight/obese. About 46% (n=57) thought the condition is inherited and 44 %(n=55) considered it to be due to physical inactivity. On risk reduction measures, 63.1% (n=65) adopted a proper diet, 38.8 %(n=40) engaged in physical activities and 18.5 % (n=19) loss weight. In addition, 13.6 %(n=14) attempted to stop alcohol/tobacco use and 8.7% (n=9) preferred regular check-up. Marital status, level of education and employment status were significantly associated with knowledge pre diabetes (p-value< 0.05). Our findings show that patients who were already pre-diabetic state had inadequate knowledge about risk reduction measures. The difference in knowledge about risk reduction behaviors between pre diabetics and the rest of the respondents was statistically significant (P-value< 0.05). We therefore recommend more health promotion efforts on risk reduction measures for those affected and unaffected within this populations and elsewhere.