Diabetes Miletus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of DM is associated with long-term damage, dysfunction, and failure of different organs, e.g. eyes, kidneys, nerves, heart, and blood vessels. The underlying causes of the DM are genetic and environmental factors e.g. urbanization and industrialization, increased longevity, modern sedentary lifestyles, and over-consumption of energy-dense foods. This study investigated the spatial variation in the spread of DM incidence in eleven wards in the city of Makurdi which are; Ankpa/Wadata, Bar, Fiidi, Central Southern Mission, Clerks, Modern Market, North Bank I, North Bank II, Wailomayo, Mbalagh and Agan to unravel their underlining causes. Bar ward had the highest number of DM incidence at 19.1%, Wailomayo ward 18.6%, and Fiidi had 18.1%. Type 2 DM had the highest incidence at 95% while type 1 DM accounted for 4.5% and gestational DM accounted for 0.5% of the total incidence. The high rate of type 2 DM is a result of an unhealthy diet (fast food, excess refined sugar, excess salt, low fiber), overweight/obesity, lack of regular physical exercise, excessive use of alcohol, advancing age, hypertension, family history, etc. The distribution of DM in Makurdi metropolis is clustered in Bar (19.1%), Wailomayo (18.6%), and Fiidi (18.1%) wards and across the major hospitals in the city which are the Federal Medical Centre (FMC) and the General Hospital(GM), 63% of DM incidence was reported at FMC with Fidi ward having 83.3% of the cases while 37% of DM patients reported at GM had 79.2% cases from North Bank I. One Way Analysis of Variance (ANOVA) result revealed a significant variation in the incidence of DM across different residential densities in Makurdi metropolis (F2, 196 = 3.341; p<0.05).