Background: Terminalia chebula Retz. (Combretaceae) is a medicinal herb using in traditional medicine worldwide and has hypoglycemic effects in animal models. Objectives: The present study was a double-blind, placebo-controlled trial designed to study the effect of T. chebula fruit water extract (TFWE) in pre-diabetic subjects. The efficacy of TFWE and placebo were compared in terms of reducing fasting blood sugar (FBS) levels, body mass indexes (BMI), body circumferences and skinfold thicknesses. Adverse events of TFWE intervention were also investigated. Materials andMethods: TFWEwas phytochemically quantitated by HPLC analysis and its inhibitory action on alpha-glucosidase. In a clinical study, 80 pre-diabetic healthy subjects were classified according to BMI as normal weight and overweight and each group was further divided into 2 groups. The treatment group received 2 capsules of TFWE 500 mg, 2 times per day, before meals for 8 weeks and the control group received 2 placebo capsules, taken orally as the treatment group. Data was collected at week 0, 4 and 8 of the study. Results: For overweight participants receiving TFWE, the mean FBS levels were significantly lower than that of the placebo group (p = 0.026) at week 8. Visceral fat levels also showed a significant reduction (p = 0.039) compared to the placebo group. TFWE dispensation did not show serious adverse events. Conclusion: The administration of 2,000 mg TFWE per day was considered safe for the pre-diabetic healthy subjects with benefits in obesity management.