To determine the association between known risk factors (e.g., obesity, metabolic syndrome and its components) and the development of pre-diabetes or diabetes over time in a cohort of Mexican health workers. Methods Participants in the Mexican Health Worker Cohort Study with complete information at two waves of data collection, 2004-2006 (W1) and 2011-2013 (W2), were included in the analysis (n = 1,174). Multivariable binary and multinomial logistic regression were used to examine the cross-sectional associations between specific risk factors and diabetes status (diabetes, pre-diabetes, or neither) at W1 and the longitudinal associations between changes in risk factors and progression of diabetes status from W1 to W2, respectively. Results Mean time between waves was 7.0 years (SD 1.1). Prevalence of pre-diabetes and diabetes was 16% and 10% at W1 and increased to 30% and 16% at W2, respectively. The crosssectional prevalence of pre-diabetes and diabetes was significantly higher among men, participants over the age of 45 years, and individuals who were overweight or obese or had metabolic syndrome (MS), three or more components of the MS, elevated alanine aminotransferase (ALT) levels, or elevated uric acid. In longitudinal analyses, remaining obese or gaining weight between waves was associated with an increased risk of developing pre-diabetes. A greater risk of developing pre-diabetes or diabetes was also observed among