BACKGROUND AND AIMS: COVID-19 pandemic and lockdown measures to contain it have affected health care services globally. This study aims to assess the effect and urban-rural differences of COVID19 pandemic on diabetes care. METHODS: This cross-sectional study was conducted among persons with diabetes (PWDs) registered for care at a diabetes clinic of a tertiary care center in Southern India. We collected following information by telephonic interviews: physician consultations, access to diabetes medications and blood sugar tests, use of telemedicine services, out of pocket expenditure and psychological morbidity. RESULTS: A total of 350 PWDs were interviewed. Majority were male (78%) and from rural areas (79%). One fourth (24%) met any physician for diabetes care at least once during lockdown. PWDs from rural areas mainly consulted a physician in a private clinic (55%) compared to urban areas (26%). Two third (65%) availed medications from private medical shops. Almost half (46%) got their blood sugar tested during and majority of them (81%) reported unsatisfactory glycemic control. Only few (5%) was aware and three utilized telemedicine services. Almost all (99%) spent money (US $ 8.3) for diabetes care. One third (33%) had moderate or high psychological distress. CONCLUSIONS: Majority of PWDs did not consult a physician during lockdown. Cost of care was high. Measures to improve utilisation of telemedicine services and peripheral health facilities are needed.