Objective To assess the trend of prevalence, awareness, treatment and control rate of diabetes among elderly residents (≥45 years old) of Shunqin District in Nanchong City, and provide scientific references for the prevention and control of diabetes. Methods From February 2013 to August 2015, a cross-sectional survey was conducted in 9 sub-district offices of Shunqing District of Nanchong City. Households as a unit, the questionnaires and blood tests were investigated by clustering sampling in residents aged ≥45 years old. Results A total of 82 225 residents with complete information were enrolled in this study. Among them, 11 857 were with diabetes, in whom 6 260 had been diagnosed as diabetes before, only 5 054 were under treatment, and only 1 986 could control blood glucose to target level. The prevalence of diabetes was 14.4% among the participants. The rate of awareness, treatment, and control of diabetes in the 11 857 diabetes patients identified was 52.8%, 42.6%, and 16.7%, respectively. Conclusions The prevalence rate of diabetes is high, but the rate of awareness, treatment, and control of diabetes is low. It is necessary to popularize the knowledge and the cognition of diabetes, and it is urgent to make efficient measures to prevent and control diabetes in Nanchong City.