Even among policy makers at an international and national level, awareness about the public health and clinical importance of diabetes remains low. Diabetes is widely perceived as a condition of low importance to the poorer populations in the world. In the low- and middle-income countries, the impact of diabetes is largely unrecognized. Yet the world is facing a dramatic rise in diabetes prevalence, most of which will occur in the low- and middle-income countries. This will have a major impact on the quality of life of hundreds of millions people and their families, overwhelm the capability of many national health-care systems, and impact adversely upon the economy of those countries that are in most need of development. In this article, Nigel Unwin and Amanda Marlin report on Diabetes Action Now, an international initiative to raise awareness about the condition and stimulate effective measures for its surveillance, prevention and control.