Abstract: Objective To investigate the prevalence and associated factors of diabetes and pre-diabetes in adults aged 20-80 in Gansu province. Methods A cross-sectional study was conducted in Gansu province in 2016. The study sites were selected by using a multi-stage stratified cluster sampling method. Face-to-face questionnaire interview and physical examinations were conducted in all participants. The standardized prevalence was calculated with the direct standardization method. Logistic regression models were used to analyze the associated factors. Results The prevalence of diabetes in Gansu province was 7.33% (male:10.59%, female:4.98%), and 18.75% for prediabetes (male:20.50%, female:17.50%). The age-and gender-standardized prevalence of diabetes was 5.77% (male:7.63%, female:3.86%), and 16.22% for prediabetes (male:18.49%, female:13.88%). The prevalence of diabetes was higher in urban than in rural participants. In urban residents, the prevalence of diabetes was higher in men than in women. Logistic regression analysis indicated that male, older age, overweight, hypertension, family history of diabetes, and dyslipidemia were risk factors for both diabetes and pre-diabetes. Living in rural areas and alcohol consumption were protective factors for diabetes. Conclusions The prevalence of diabetes and pre-diabetes was lower in Gansu province than in the general population. The prevalence of diabetes was higher in urban areas than in rural. The population who were male, older age, overweight, had hypertension, family history of diabetes and dyslipidemia were in high risk of diabetes and pre-diabetes, which need strengthened intervention.