Type 2 diabetes is a global public health crisis, particularly in developing countries, driven by rapid urbanization, nutrition transition, and sedentary lifestyles. Asia, with its large population and rapid economic development, has become a center of the diabetes epidemic, characterized by younger onset and lower BMI levels compared to Caucasian populations. Contributing factors include the "normal-weight metabolically obese" phenotype, high smoking and alcohol use, high intake of refined carbohydrates, and decreased physical activity. Poor nutrition in utero and early life, combined with overnutrition later in life, also play a role. Recent advances in genome-wide association studies have improved understanding of diabetes pathophysiology but do not fully explain ethnic differences in risk. Epidemiologic studies and clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications, but translating these findings into practice requires fundamental changes in public policies, food and built environments, and health systems. Primary prevention through promoting healthy diets and lifestyles should be a global public policy priority to curb the escalating diabetes epidemic.Type 2 diabetes is a global public health crisis, particularly in developing countries, driven by rapid urbanization, nutrition transition, and sedentary lifestyles. Asia, with its large population and rapid economic development, has become a center of the diabetes epidemic, characterized by younger onset and lower BMI levels compared to Caucasian populations. Contributing factors include the "normal-weight metabolically obese" phenotype, high smoking and alcohol use, high intake of refined carbohydrates, and decreased physical activity. Poor nutrition in utero and early life, combined with overnutrition later in life, also play a role. Recent advances in genome-wide association studies have improved understanding of diabetes pathophysiology but do not fully explain ethnic differences in risk. Epidemiologic studies and clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications, but translating these findings into practice requires fundamental changes in public policies, food and built environments, and health systems. Primary prevention through promoting healthy diets and lifestyles should be a global public policy priority to curb the escalating diabetes epidemic.