Aims To study symptom burden among older people and its associations with change in glucose metabolism status over a 7-year period. Methods We conducted a prospective population-based cohort study among 397 older people. We used the revised Diabetes Symptom Checklist to assess symptom burden. Glucose metabolism status was determined using an oral glucose tolerance test. Analyses were adjusted for multiple confounders, including cardiovascular risk and risk of depression (Center for Epidemiological Studies Depression Scale score 16). Results Revised Diabetes Symptom Checklist total scores (range 0-100) increased slightly over time among people with normal glucose metabolism (mean difference 1.04; P = 0.04) and those with impaired glucose metabolism (1.96; P = 0.01), but not among people with Type 2 diabetes (0.46; P = 0.55). These associations between symptom burden and glucose status were attenuated after full adjustment for multiple confounders and remained statistically significant for those with impaired glucose status. Linear mixed models showed significant mean differences in revised Diabetes Symptom Checklist total scores over time when comparing people with Type 2 diabetes with those with normal or impaired glucose metabolism, but not when comparing subjects with impaired vs normal glucose metabolism; these results did not alter after full adjustment. Conclusions Symptom burden increased gradually over time in the people with impaired glucose metabolism and those with normal glucose metabolism, but not in patients with Type 2 diabetes over a 7-year follow-up period. What's new? This is the first study investigating diabetes-related symptom burden among older people and its associations with a change in glucose metabolism status over a 7-year period. The results indicate that symptom burden increases gradually over time among the participants with impaired glucose and those with normal glucose status, but not among patients with Type 2 diabetes. Prospective studies are needed in larger populations, including data on comorbidities and information about diabetes treatment, given the potential of treatment to reduce diabetes complications and subsequent symptom burden .