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Abstract: Aims: To determine the change in prevalence, incidence and risk factors associated with diabetes and impaired fasting glucose (IFG) in a rural Korean area. Methods: Initially a total of 1119 subjects (424 men and 695 women) aged 31–99 years were recruited in 1997. Baseline clinical data and various laboratory values were obtained. Six years later, we visited the same area and measured similar parameters in 814 subjects (316 men and 498 women) of which 558 were original participants and 256 subjects were new. Incidence and risk factors of diabetes were analyzed in 518 subjects. Diabetes and IFG were defined according to American Diabetes Association criteria. Results: Age- and sex-adjusted prevalence of diabetes in 1997 was 6.9%, increasing to 11.7% in 2003. The prevalence of IFG increased alarmingly from 21.9% in 1997 to 38.8% in 2003. The age- and sex-adjusted incidence rate of diabetes was 16.3 per 1000 person-years. Baseline fasting plasma glucose, 2h post-load glucose, abdominal circumference and urinary albumin excretion rate (UAER) acted as independent risk factors for diabetes in a multivariate logistic regression analysis. Conclusions: The prevalence of diabetes and IFG increased markedly from 1997 to 2003, indicating the need for urgent preventive measures. Fasting and 2h post-load glucose, abdominal circumference and UAER independently predicted the development of diabetes in this rural Korean population. [Copyright &y& Elsevier]