This study aimed to uncover the changing prevalence of pre-diabetes and diabetes as well as diabetes self-management behaviors across socioeconomic gradients in rural southwest China.A two-wave, community-based, cross-sectional survey was conducted. A total of 7,747 and 7,536 individuals aged ≥ 35 years, residing in rural southwest China, were selected using a three-stage stratified random sampling method. Demographic characteristics and self-management behaviors were collected through face-to-face interviews, and physical indicators were measured through on-site examinations. An individual socioeconomic position (SEP) index was constructed using principal component analysis based on three variables: education, annual household income, and access to medical services.In 2022, the overall prevalence of pre-diabetes and diabetes (15.7% and 7.6%) were lower than in 2013 (18.3% and 8.2%) (P < 0.05). This decline was also observed in subgroups including women, those aged 45-54 years, those of Han ethnicity, those with a high educational level, those with a high annual household income, and those with good access to medical services and high SEP (P < 0.05). In contrast, higher rates were found among ethnic minorities, those with low annual household income, and those with low SEP. The overall rate of compliance with anti-diabetic medications or insulin injection was higher in 2022 (95.9%) compared to 2013 (76.5%), with the largest relative increase occurring among participants with a low level of education and income, poor access to medical services, and low SEP (P < 0.01). The proportion of individuals having taken measures to control diabetes was lower in 2022 (39.7%) compared to 2013 (53.3%) (P < 0.01). This lower rate was also observed among the subgroups categorized by sex, education, and income level, in the Han majority, and among participants with good access to medical services and high SEP (P < 0.05). Furthermore, while the overall rate of regular self-monitoring of blood glucose did not differ between the two survey years (41.8% and 44.7%, P > 0.05), a higher rate was uncovered among patients with low education level, low annual household income, poor access to medical services, and low SEP in 2022 compared to 2013 (P < 0.05).The prevalence of pre-diabetes and diabetes, as well as the rate of taking measures to control diabetes, were lower among the rural Chinese adult population in 2022 compared with 2013. However, compliance with anti-diabetes medications or insulin injections was higher. Additionally, socioeconomic disparities are associated with these Changes.© 2025. The Author(s).