Diabetes became a global pandemic within only a few decades, and is now ravaging both the developed and developing worlds. Physicians, while competing with this “new” challenge are focusing mostly on the serum blood levels and diabetic complications; and in the best case, to the proximate causes of the disease such as obesity, family history, age and diet. The ultimate causes of this condition, like any other civilisation disorder, lay in the evolutionary history of the human. A number of hypotheses put forth to explain the exponential increase of the diabetes prevalence with an evolutionary point of view such as; evolutionary trade-offs, developmental plasticity, thrifty genotype, life history and selfish brain alongside with the disrupting change in human diet. Finally, four main interacting predisposing factors to consider in planning the diabetes control activities are prominent: Genes, prenatal environment, diet and physical activity. If the former two are difficult to act on, the latter two need to be introduced in the agenda of all the parties.