OBJECTIVES: Early metabolic abnormalities that precede diabetes (impaired fasting glucose and impaired glucose tolerance) are associated with increased mortality. Our study aimed to assess the relationship between random glucose levels and development of all-cause mortality, specifically considering the differences between normal, high-normal glucose, pre-diabetes and diabetes. METHODS: A retrospective cohort study using a limited dataset from the Framingham Heart Study was employed. Baseline-period was in 1956, each patient was followed 24 years. Random glucose was grouped into normal, high-normal, pre-diabetes, and diabetes. Ages, gender, body mass index, and blood pressure were examined. Outcome measure was all-cause mortality. Bivariate and multivariate cox proportional hazards regression models controlling for demographics and risk factors were performed to compare the risk of death between different random glucose levels. RESULTS: The study cohort consisted of 3,270 survey patients with a mean age 50(±8.68), of which 1,825(55.8%) were female. During the follow-up period, 1,178 patients deceased. The average follow-up time was 20 years; while average survival time for patients who deceased was 14 years. Compared to normal random glucose, high-normal (Hazard Ratio[HR]:1.486; Confidence Interval[CI]:1.24 –1.77), pre-diabetes (HR:3.328; CI:2.237–4.951) and diabetes (HR:5.314; CI:3.754–7.523) were significantly associated with increased risk of all-cause death in the bivariate Cox regression model. In adjusted model, high-normal glucose level (HR:1.216; CI:1.019–1.45), pre-diabetes(HR:2.458; CI:1.647–3.667), and diabetes (HR:3.164; CI:2.214– 4.521) were significantly associated with increased risk of death compared to normal glucose group; age and hypertensive systolic blood pressure were associated with increased risk of all-cause death; while female gender was significantly associated with decreased risk of death. CONCLUSIONS:   Random glucose alone can predict risk and even high-normal levels are associated with increased mortality. Our findings are of value especially when considering cost-effective strategies in screening underserved populations throughout the globe, where medical resources are scarce and fasting glucose levels are difficult to obtain.