Aims: To assess cumulative glycemia, microvascular characteristics, and associated risk factors for diabetes in subjects with impaired glucose regulation. Methods: Cross-sectional, population-based study comprising systemic characteristics in 6487 participants and ocular characteristics in 970 participants. Results: Lens fluorescence, a quantitative index of life-long cumulative glycemia, was increased by 7.5% (CI 95 0.37-15.1%) in subjects with impaired fasting glucose, by 13.0% (CI 95 5.5-21%) in subjects with combined impaired fasting glucose and impaired glucose tolerance (IFG+IGT), and by 11.8% (CI 95 6.8-17.1%) in subjects with screen-detected diabetes compared to normoglycemic subjects, adjusted for age, sex, and smoking. The prevalences of microalbuminuria and retinopathy were significantly increased in subjects with screen-detected diabetes after adjusting for age, sex and systolic blood pressure. The prevalences of associated risk factors for diabetes were elevated in all categories of abnormal glucose regulation compared to normoglycemic subjects. Conclusions: Life-long cumulative glycemia, microangiopathy, and associated risk factors for diabetes were significantly elevated in subjects with abnormal glucose metabolism, most prominently in subjects with IFG. +. IGT and in subjects with screen-detected diabetes. These results provide the first objective evidence that cumulative glycemic load is increased at the earliest stage of impaired glucose regulation.