Background and Objective: Obesity and diabetes are escalating public health issues in Africa. Ghana has a high and increasing prevalence of obesity and diabetes, associated with dietary changes, sedentary lifestyles and urbanization. However, most prior studies have focused on urban areas, with limited data on nationwide prevalence, particularly in semi-urban and rural settings. This study aimed to determine the prevalence of diabetes among obese adults in the semi-urban Madina municipality and environs in Ghana.It also examined associated demographic and lifestyle factors. Materials and Methods: This cross-sectional study surveyed 106 obese adults aged $18 years in Madina using questionnaires and anthropometric measurements. Fasting blood sugar (FBS) was measured to assess diabetes status. Data was analyzed using the Statistical Package for Social Sciences (SPSS). Results were computed in graphs and tables using Microsoft Office. Results: Most participants were urban, female, single and educated to at least a basic level. Diabetes prevalence was 15% based on elevated FBS. The highest prevalence was among those with basic education (19%) and the lowest was in students (5%). Diabetes was more common in urban residents (15%) than in rural (17%) or peri-urban (16%). High diabetes prevalence was found in those engaged in trading (26%) and self-employment (22%). Diets high in refined carbohydrates are associated with poorer blood sugar control. A family history of diabetes and hypertension was a risk factor for high FBS. Conclusion: Diabetes prevalence was significant among obese adults in this semi-urban region of Ghana. Lower education, urban residence, unhealthy diets, family history and occupations like trading confer higher diabetes risk. Preventive interventions should target these vulnerable subgroups.