Background: The management of older adults with type 2 diabetes mellitus (T2DM) has not been previously assessed in nursing homes within the Caribbean region. Aims: To investigate the prevalence of T2DM among residents of French Caribbean nursing homes and to characterize their health and functional status. Methods: This cross-sectional study is based on baseline screening data from the KASEHPAD (Karukera Study of Ageing in Nursing Homes) cohort. Clinical characteristics and standard geriatric parameters were systematically collected and analyzed. Hemoglobin A1c (HbA1c) levels of older adults with diabetes were retrospectively extracted from patient records. Results: A total of 332 participants aged 60 years or older were recruited from six nursing homes between September 2020 and November 2022. The prevalence of T2DM among residents was 28.3% (95% CI: 23.5–33.2). Among older adults with T2DM, 85.1% had hypertension, 17.1% had heart failure, and 24.1% had a history of stroke. The mean HbA1c level was 7.32 ± 1.5%. Of the 35 individuals (42.7%) with HbA1c < 7%, 19 (54.3%) were receiving antidiabetic medications. Multivariate analysis identified HbA1c as the sole factor significantly associated with antidiabetic medication use (OR: 1.76, 95% CI: 1.12–3.04). Discussion: Older adults with T2DM residing in French Caribbean nursing homes exhibit a high prevalence of cardiovascular risk factors and are at risk of overtreatment. The management of T2DM in this population appears to be driven primarily by blood glucose levels. Conclusion: As the prevalence of older adults with T2DM is expected to rise in the Caribbean region, this trend will present significant challenges in delivering tailored care within future nursing home settings. © The Author(s) 2025.< Réduire