Objective  To examine the prevalence and disease economic risk of diabetes mellitus (DM) among rural older residents in Midu county of Yunnan province and to provide references for developing intervention measures.

  Methods  We conducted questionnaire survey and fasting blood glucose test among 1 603 rural residents aged ≥ 60 years selected with stratified multi-stage random sampling in Midu county of Yunnan province from January to March 2017.

  Results  Among all the participants, 162 were identified with DM and the prevalence of DM was 10.11%. Significantly lower DM prevalence (8.10%) was found among the participants with per capita annual income of less than 5 000 RMB yuan than that (11.41%) among those with the income of 5 000 yuan and more (χ² = 4.619, P = 0.032). Compared to all the participants, the participants with DM reported higher average annual medical expenditure (2 545 yuan vs. 2 252 yuan) but lower annual income (5 603 yuan vs. 5 900 yuan). The participants with DM had a 1.13 times higher economic risk than all the participants (relative risk, RR = 1.13) and the increased risk was 1.19 after standardized adjustment. Among the 91 households with family members suffering from DM, the incidence of catastrophic health expenditure and poverty due to illness were 16.48% and 9.89%; the incidence of illness-induced poverty was significantly higher in the households with annual income per capita of less than 5 000 yuan than in the households with the income of 5 000 yuan and more (15.7% vs. 2.5%, P < 0.05); while, the incidence of illness-induced poverty was significantly lower in the non-poverty-stricken households than in the poverty-stricken households (7.3% vs. 33.3%, P < 0.05).

  Conclusion  The prevalence of diabetes mellitus is higher among the rural elderly with higher annual income and the households with elderly family members suffering from diabetic mellitus are at a greater disease-related economic risk in Midu county of Yunnan province. The results suggest that medical and financial supports should be strengthened for low income and poor access to medical service households with older diabetic patients.