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Background: Uncontrolled diabetes mellitus is a significant health challenge, especially in developing countries. Factors contributing to it vary by region, making it crucial to understand them for effective blood sugar control. The study’s objectives were to estimate the prevalence of uncontrolled diabetes mellitus and its determinants among residents of selected areas of Dakshina Kannada, Karnataka. Methodology: This study was conducted from October 2021 to May 2023 among adult diabetics residing in the Jokatte and Madani Nagar areas of Dakshina Kannada. The required sample size was estimated at 180 and 90 diabetic patients were randomly selected from each study area. Data were collected by field workers using a pre-tested questionnaire, and a lab technician obtained blood samples for HbA1c. Data analysis was performed using SPSS Ver 27. Results: The study enrolled 180 diabetics with a mean (± S.D) age of 56.9 (±10.3) years. Uncontrolled diabetes was noted in 75.6% of diabetics. Significant determinants for uncontrolled diabetes were longer duration of diabetes, poor knowledge of blood sugar tests, irregular testing and insufficient physical activity. Conclusion: The study observed an alarming prevalence of uncontrolled diabetes and identified its key determinants. Healthcare providers must implement targeted interventions addressing these factors to achieve effective diabetes control.