Aims: The purpose of this study is to explore the perceptions and practices of diabetes management through focus group discussions (FGDs) among adults with diabetes in rural Tamil Nadu. Materials and Methods: A qualitative study was conducted among individuals with diabetes who were part of the Telemedicine pRoject for screENing Diabetes and its complications in rural Tamil Nadu (TREND). A total of 16 FGDs were conducted using a semi-structured FGD guide that elicited perceptions of the different aspects of diabetes management and knowledge about diabetes prevention. The sample size was based on the attainment of thematic saturation. All FGDs were audio-recorded and transcribed verbatim. The textual data was then coded into meaning units and grouped into themes. Data were analyzed using NVIVO software version 10.0. Results: There were varied responses with respect to diet, medication adherence, regularity of follow-up, knowledge about diabetes, and diabetes prevention. Most participants had limited knowledge of the disease and did not have regular hospital visits. Several participants were unable to adhere to the diet prescribed by healthcare providers, as they lived alone or were dependent on someone in the family for dietary needs. Most participants were unaware that diabetes could be prevented. Some participants were interested in serving as “Diabetes ambassadors” to educate rural societies about diabetes. Conclusions: Understanding the perceptions and practices about diabetes management and prevention strategies could help primary healthcare workers effectively treat, manage, and prevent diabetes in underserved rural populations.