OBJECTIVES: Understanding the impact of diabetes on quality of life may provide impetus for education and prevention. This study assessed differences in health-related quality of life (HRQoL) across respondents with type 2 diabetes (T2D) and groups with varying levels of cardiometabolic risk for developing T2D. METHODS: The Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) is a US longitudinal study of individuals with or at risk for T2D. Respondents without diabetes but with 3-5 cardiometabolic risk factors for T2D (abdominal obesity, BMI ³28 kg/m2, reported diagnosis of cholesterol problems, hypertension or coronary heart disease or stroke) were classified as high risk and respondents with =2 of these risk factors as low risk. HRQoL was measured by the EQ-5D visual analog scale (VAS) and index utility score. Baseline mean VAS and utility scores (using US population values) were compared across the three respondent groups using analysis of variance with post-hoc testing. RESULTS: Mean VAS scores for T2D and high-risk respondents (66.8 and 70.4, respectively) were significantly reduced compared with low-risk respondents (79.6, p<0.001). Mean index utility scores for T2D and high-risk groups (0.78 and 0.79, respectively) were substantially lower than those for low-risk group (0.87, p<0.001). Additionally, the mean VAS and utility scores for T2D respondents were significantly lower than those of high-risk respondents (p<0.001). Greater decrements were reported in all domains by T2D and high-risk respondents compared with low-risk respondents, with the largest difference in decreased mobility (47.9%, 43.4%, 17.1%, respectively). CONCLUSION: SHIELD results demonstrated that respondents with or at higher risk for T2D report decreased overall HRQoL, resulting from lower scores in every domain, compared with those at low risk. Even before T2D diagnosis, reducing cardiometabolic risk levels may lead to significant improvement in HRQoL.