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High circulating free fatty acid (FFA) is associated with the development of diabetes. This study was designed to evaluate longitudinal associations between FFA levels, changes in FFA levels, and mean FFA levels and incident diabetes. This 3-year cohort study was conducted in Ningyang between 2011 and 2014. Serum FFA, fasting blood glucose (FPG), 2-hour postprandial blood glucose (2hPG), and glycosylated hemoglobin (HbA1c) levels were measured at baseline and at the end of follow-up. A multivariate stepwise logistic regression model wa