The prevalence of diabetes in Africa is predicted to increase by 80% in 2025 and impact younger working age patients. We increasingly live in an obesogenic society that drives the global pandemic of Type 2 diabetes. The powerful commercial, socio-economic and political factors shaping this society encourage individual choices that lead to a sedentary and unhealthy lifestyle. These factors are increasingly seen in lower income countries. The metabolic syndrome is now an established entity which can be identified and treated prior to the development of diabetes. In sub-Saharan Africa there is an emerging relationship between the HIV and diabetic epidemics. For example HAART leads to a higher risk of diabetes and diabetes increases the risk of infections such as TB. The quality of care in sub-Saharan Africa can be improved with relatively simple measures if they are implemented consistently and guidelines have been developed for this context. A vision for the way forward in Africa has been expressed in the 2006 African Diabetes Declaration.