Background/aims: Isolated retinopathy signs are common in non-diabetic individuals and have been shown to be associated with impaired glucose metabolism. In a cohort of people without diabetes,the association of these retinopathy signs and subsequent development of diabetes were examined. Methods: A population based cohort study of 7992 people aged 49-73 years without diabetes was conducted. Retinal photographs of these participants were evaluated for the presence of retinopathy signs according to a standardised protocol. Incident cases of diabetes were identified prospectively. Results: After a follow up of 3 years,291 (3.6% ) people developed incident diabetes. In the total cohort,retinopathy was not significantly associated with incident diabetes (4.7% v 3.6% ,multivariable adjusted odds ratio (OR) 1.1,95% confidence intervals (CI),0.7 to 1.9). However,among participants with a positive family history of diabetes,retinopathy was associated with incident diabetes (10.4% v 4.8% ,multivariable adjusted OR 2.3,95% CI,1.0 to 5.3). Among participants without a family history of diabetes,retinopathy was not associated with incident diabetes Conclusions: In individuals with a family history of diabetes,retinopathy signs predict subsequent risk of clinical diabetes. Background / aims: Isolated retinopathy signs are common in non-diabetic individuals and have been shown to be associated with impaired glucose metabolism. In a cohort of people without diabetes, the association of these retinopathy signs and subsequent development of diabetes were examined. Methods: A population based cohort study of 7992 people aged 49-73 years without diabetes was conducted. Retinal photographs of these participants were for for the presence of retinopathy signs according to a standardized protocol. Incident cases of diabetes were identified prospectively. Results: After a follow up of 3 years, 291 (3.6%) people developed incident diabetes. In the total cohort, retinopathy was not significantly associated with incident diabetes (4.7% v 3.6%, multivariable adjusted odds ratio (OR) 1.1, 95% confidence intervals ), 0.7 to 1.9). However, among participants with a positive family history of diabetes, retinopathy was associated with incident diabetes (10.4% v 4.8%, multi variable adjusted OR 2.3, 95% CI, 1.0 to 5.3). Among participants without a family history of diabetes, retinopathy was not associated with incident diabetes Conclusions: In individuals with a family history of diabetes, retinopathy signs predict subsequent risk of clinical diabetes.