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Objectives To explore the associations between arterial stiffness (AS) onset age and type 2 diabetes mellitus (T2DM) risk.Design Large-scale cohort study.Setting The largest medical centre in central China.Participants This study enrolled 22 588 participants free of T2DM at baseline. All participants took an annual physical examination from 2012 to 2016, with fasting blood glucose and brachial–ankle pulse wave velocity measurements.Primary and secondary outcome measures Cox proportional model was used to investigate the association between AS onset age and T2DM risk. Sex-specific analysis was also performed, and the association between early vascular ageing (EVA), normal vascular ageing (NVA), supernormal vascular ageing (SUPERNOVA) onset age and diabetes risk was also examined.Results A total of 757 (3.4%) participants were diagnosed with T2DM. Compared with participants free of AS in each specific age group, the earlier AS onset age was more strongly associated with T2DM risk, especially for middle age, with the fully adjusted hazard risk (HR) and 95% CI of 4.63 (2.79–7.67) for AS onset age at 50. Similar results were observed both in males and females, with the fully adjusted HR and 95% CI of 4.54 (2.60 to 7.93) for males and 4.86 (1.48 to 16.01) for females, with AS onset age at 50. Such an association was also observed in the exploration of EVA, NVA and SUPERNOVA onset age and incident T2DM risk.Conclusion This study revealed that the middle-aged onset of AS was more significantly associated with a higher T2DM risk. Early screening of AS, especially in middle age, may assist in T2DM detection and postpone diabetic vascular complications.