According to the World Health Organization (WHO), diabetes now affects nearly one in 11 adults.
In a major report, the WHO warned cases had nearly quadrupled to 422 million in 2014 from 108 million in 1980.
High blood sugar levels are a major killer – linked to 3.7 million deaths around the world each year, it says.
WHO officials said the numbers would continue to increase unless “drastic action” was taken.
As the world’s waistlines have ballooned – with one-in-three people now overweight, so too has the number of diabetes cases.
Failing to control levels of sugar in the blood has devastating health consequences.
Diabetes triples the risk of a heart attack and leaves people 20 times more likely to have a leg amputated, as well as increasing the risk of stroke, kidney failure, blindness and complications in pregnancy.
The disease itself is the eighth biggest killer in the world, accounting for 1.5 million deaths each year.
A further 2.2 million deaths are linked to high blood sugar levels. And 43% of the deaths were before the age of 70.
In the 1980s the highest rates were found in affluent countries.
In a remarkable transformation, it is now low and middle income countries bearing the largest burden.
The Middle East has seen the prevalence of diabetes soar from 5.9% of adults in 1980 to 13.7% in 2014.
More than three quarters of teenagers in the region are doing less than the recommended level of exercise.
The WHO report said the solution required the whole of society to act.
It is only by keeping blood sugar levels in check that the deadly complications of the disease can be contained.
The report showed that two thirds of low income countries were not able to provide blood sugar monitors or drugs such as insulin or metformin for most people.