Diabetes mellitus ranks high on the international health agenda as a global pandemic and as a threat to human health and global economies. A total of 10851 participants aged over 40 years were included in the cross-sectional analysis. This observational study analyzed the prevalence of diabetes mellitus and the awareness, treatment and glycemic control of diabetes in a rural Chinese population. Approximately 25% of middle-aged and elderly rural Chinese residents had diabetes in 2010-2011. The prevalence was higher with older age, dyslipidemia, higher body mass index and larger waist circumference. Among the subjects with diabetes, 40.3% were aware of their condition; 62.9% were receiving treatment, and 16.9% had controlled diabetes. Metformin was the majority oral antidiabetic drug treatment most often prescribed, for either monotherapy or combined therapy. These results indicate that diabetes has become an urgent public health problem in the Chinese rural population because of its high prevalence and low rates of awareness, treatment and control. The management and prevention of diabetes mellitus should be considered an essential strategy at the level of public health.