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Objectives This study aimed to assess the prevalence of diabetes and associated risk factors and to deepen understanding of the diabetes burden in Ga Mashie, an urban-poor area in Accra, Ghana.Design Cross-sectional epidemiological cluster survey.Setting and participants We surveyed adults aged over 25 years in 80 enumeration areas within Ga Mashie, targeting 959 randomly selected households based on the 2021 census.Outcome measures Household-level data included household membership and structure, water and sanitation, cooking infrastructure and asset ownership. Individual-level data encompassed demographics, lifestyle behaviours and biometric measurements. Diabetes was identified through random blood glucose levels ≥11.1 mmol/L or a prior diagnosis, with obesity defined as a body mass index >30 kg/m 2 and central obesity as a waist circumference-to-height ratio >0.5. We derived weighted prevalence estimates and compared these estimates by age, sex and wealth using unadjusted ORs.Results The survey, achieving a 67% response rate, covered 854 individuals from 644 households. It unveiled a notable prevalence of risk factors known to be associated with diabetes: 47.2% for alcohol consumption (95% CI 43.7% to 50.8%), 50.7% for insufficient physical activity (95% CI 46.0% to 55.3%), 28.9% for unhealthy snack consumption (95% CI 24.5% to 33.7%), 35.1% for obesity (95% CI 31.3% to 39.1%) and 74.5% for central obesity (95% CI 70.8% to 77.9%). Diabetes affected 8.2% of the population aged ≥25 (95% CI 6.4% to 10.5%), with disparities evident across age, wealth and sex (2.66 greater odds in females for diabetes (95% CI 1.38 to 5.12)).Conclusion Diabetes and its risk factors are highly prevalent in Ga Mashie, with significant demographic disparities underscoring the need for targeted interventions. The study highlights the critical challenge diabetes poses in urban-poor contexts, emphasising the necessity for tailored health initiatives to mitigate this burden.