Background: Diabetic nephropathy (DN) is a major microvascular complication of Type 2 Diabetes Mellitus (T2DM) and a leading contributor to chronic kidney disease and end-stage renal disease worldwide. In Ghana, limited routine screening and delayed diagnosis may increase the burden of DN and worsen outcomes. This study assessed the prevalence of DN and examined socio-demographic, clinical, lifestyle, and dietary factors associated with DN among adults with T2DM. Methods: A cross-sectional descriptive study was conducted among 201 adults with confirmed T2DM attending the Diabetic Unit of Tetteh Quarshie Memorial Hospital, Akuapem North Municipality, Ghana. Participants were recruited using convenience sampling. Sociodemographic and lifestyle characteristics were collected using a structured intervieweradministered questionnaire, while relevant clinical information was obtained from medical records. Diabetic nephropathy was assessed using urine albumin–creatinine ratio (UACR) and classification of severity. Associations between DN and explanatory variables were examined using Chi-square or Fisher’s exact tests, with statistical significance set at p < 0.05. Results: The prevalence of diabetic nephropathy among participants was 33%. The study population was predominantly female (87.6%) and older adults (≥60 years: 66.2%). Sociodemographic analysis showed that occupation was significantly associated with DN (p = 0.044), while age (p = 0.073) and gender (p = 0.058) demonstrated borderline associations. Lifestyle and clinical factors revealed that monthly exercise was significantly associated with DN (p = 0.040). Other factors such as salt intake, alcohol consumption, fruit and vegetable intake, duration of diabetes, hypertension status, medication knowledge, and family history of diabetes or hypertension were not statistically significant (p > 0.05). Hypertension prevalence among participants was high (89.6%). Conclusion: Diabetic nephropathy was common among adults with T2DM in this Ghanaian clinic population. Occupation and physical activity were significant predictors of DN, indicating that both socioeconomic and lifestyle factors contribute to renal complications in diabetes. Routine DN screening and targeted lifestyle interventions—particularly physical activity promotion—should be strengthened in diabetes care to reduce disease progression and improve patient outcomes.