OBJECTIVES: As diabetes rates rise, it is important to understand the profile of those who are at-risk for developing diabetes but have not yet been diagnosed.  The aim of this study was to assess the burden for these high-risk patients.   METHODS: The current study used US 2009, EU 2008, and Japan 2008 datasets from the National Health and Wellness Survey (NHWS).  Implementing a previously-developed algorithm, all patients not diagnosed with diabetes were classified as having or not having a high risk for developing diabetes.  High-risk patients were compared with controls on heath-related quality of life (physical component summary (PCS) scores of the SF-12v2) and the number of emergency room (ER) visits controlling for demographics (country, age, gender, ethnicity, income, education) and patient characteristics (BMI and Charlson comorbidity index). RESULTS: Of patients not diagnosed with diabetes, 16.64% (n=10778) in the US, 14.33% (n=7481) in the EU, and 4.05% (n=750) in Japan were classified as being at high risk for diabetes. After controlling for demographics and patient characteristics, those at high risk reported significantly lower levels of PCS across all three countries (Adjusted Mean (Madj)=46.2 vs. 49.6, p<.0001) than controls.  The effect was stronger in the EU (M­adj=45.5 vs. M­adj=49.2) and weaker in Japan (M­adj=47.9 vs. M­adj=49.8) relative to the US (M­adj=46.6 vs. M­adj=49.7). Those at high risk reported significantly fewer ER visits (Madj=0.12 vs. M­adj=0.16, p<.0001) than controls, however, this effect was reversed in Japan in that those at high risk reported significantly more ER visits than controls (M­adj=0.21 vs. M­adj=0.12, p<.0001). CONCLUSIONS: A substantial number of patients are at a high risk for developing diabetes, particularly in the US and EU.  The physical quality of life was significantly lower, particularly in the EU and US, and in Japan this group reported significantly more ER visits than controls.