By the year 2030, >70% of people living with T2DM will reside in developing countries, and primary prevention of T2DM should be an urgent priority for such regions. The disease predominantly affects working-age persons and has a devastating economic impact, compounded by the frequent occurrence and interaction of T2DM with infectious diseases (such as AIDS and tuberculosis). Evidence from landmark T2DM prevention trials indicates that lifestyle modification is more effective, cheaper and safer than medication and provides sustained benefits. Lifestyle modification is, therefore, the most promising approach to T2DM prevention in developing countries; however, programmes adapted to their specific needs are lacking. Low-cost strategies to identify at-risk individuals, followed by the implementation of group-based, inexpensive lifestyle interventions, seem to be the best options for resource-poor countries. However, widespread implementation of T2DM prevention in developing countries will require coordinated efforts throughout society, along with comprehensive government policies and novel funding sources.