Background: the association between education and health outcomes is under-analyzed in a primary prevention context, particularly regarding the elderly population. Objective: To examine among the elderly, one of the groups more at risk of developing diabetes, whether there is a link between education and health outcomes. If this link is confirmed, exploratory explanations are pursued. These focus on preventive behaviors and risk perceptions as suggested by the literature. Methods: An observational cross sectional study was conducted in urban vulnerable areas of Lisbon, Portugal in January-February 2013. Collected data concerned the awareness of the risks associated with diabetes and related prevention habits of the elderly (such as adoption of risk behavior and health screening habits). Demographic data including education levels, age and gender were collected as well. A final sample of 356 subjects was gathered. Results: Demographic analysis of the sample indicates that it is composed by the same age strata as the general diabetic at-risk population in Portugal. Risk of developing diabetes was found to correlate significantly and negatively with education (p<0,01, r=-0,265). Concerning prevention behaviors, all subjects scored low on behaviors that are associated with the reduction of risk, the so-called modifiable risk behaviors. The effect of education on the whole set of prevention behaviors is limited. Results also show that education does not seem to have a role in a greater health screening regarding diabetes. Rather it is when the subjects perceive that they are at risk that they engage in health screening practices, doing adopt more modifiable risk behaviors. Risk perceptions are, however, influenced by education levels. All subjects scored high on the extreme complications associated with diabetes, e.g., risks that are extremely high and directly observable while they scored low on risk factors (long-term, not directly observable risks). Subjects with education scored higher than analphabets on the pathophysiology of diabetes (observable risk but of moderate intensity). Subjects scored low on awareness on risk factors. Conclusions: Formal education levels impact health outcomes concerning diabetes. Risk behaviors on diabetes do not seem to be associated with educational levels. Education plays a role in risk perceptions but its real impact needs further research. The relationship between risk perception and preventive behavior (among which modifiable risk behaviors) is complex, and it is sensitive to different risk conditions (being at risk or not).

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