INTRODUCTION: Diabetes mellitus (DM) is becoming a modern epidemic due to the high prevalence of obesity and physical inactivity. Previous studies in Greece in urban and mixed urban and rural populations, reported a prevalence of DM of less than 3%. However data concerning the prevalence of DM in exclusively rural areas of Greece are lacking. The purpose of this study was to investigate the prevalence of DM in a representative rural area of Greece. METHODS: The group studied consisted of the resident population of the villages Saint Demetreus, Adami and Metohi of the district of Argolida, Greece, according to the 2001 Greek Census. In total, 880 subjects, aged 1-99 years (410 males [46.6%] mean age [+/- standard deviation, SD] 46.7 +/- 26 yrs, 470 females-mean age [+/- SD] 48.2 +/- 24.3 years) were screened for the presence of DM. Body mass index (BMI), waist to hip ratio (WHR), personal and family history were recorded at baseline. After an overnight fast, blood samples were drawn for the determination of plasma glucose (FPG) and serum lipid profile. In the case of FPG >126 mg/dL a second determination was performed one week later. Subjects with FPG <126 mg/dL on repeated test, and those with FPG between 110 and 126 mg/dL, were invited to undergo an oral glucose tolerance test. Diagnosis of DM was based on the 1999 WHO criteria. RESULTS: The prevalence of DM was 7.8 % (95% CI: 5.9-12.5), with known diabetics being 5.3% of the population and undiagnosed diabetes being 2.5%. No significant differences were detected between males and females (7.1% vs 7.6%, p>0.05). There was a significant increase in the prevalence of DM with increasing age (age 41-50 years: 6.4% vs 71-80 years 14.1%, p<0.05). Impaired glucose tolerance was diagnosed in 3.9%, while impaired fasting glucose was diagnosed in 1.9%. Furthermore, the prevalence of obesity (BMI>30 kg/m2<) was 20.8%, while central obesity (WHR >0.90 males, >0.85 in females) was observed in 63%. Age, obesity, family history of DM, arterial hypertension and elevated triglyceride levels were significantly associated with the presence of DM (p<0.001). CONCLUSION: The prevalence of DM has significantly increased in the rural population of Greece. Age, hypertension, obesity, family history of diabetes and elevated triglyceride levels were significantly associated with prevalent diabetes. These subjects should be a primary target for preventive intervention strategies.