This presentation reviews literature on type 2 diabetes mellitus and its complications among Indigenous populations around the world. The rising prevalence and incidence of type 2 diabetes in many Indigenous populations has stimulated research focusing on the causes of diabetes including: genetic, environmental, behavioural, socio-economic and cultural factors. A more detailed exploration of the patterns, trends and care delivery considerations will be provided in three specific populations: Australian Aborigines, American Indians and Canadian Aboriginal populations. Issues of Indigenous definition, limited and outdated data on prevalence and complications, varying operational practices and research methodologies make comparisons of diabetes rates among Indigenous populations problematic. However, worldwide surveillance of people with diabetes is a necessary step toward its prevention and control. Responses in terms of prevention and treatment are presented, highlighting the importance of socially and culturally appropriate long-term, primary prevention initiatives as well as targeted clinical interventions. Primary prevention initiatives will include a discussion on community partnerships and community-based participatory strategies with an in depth examination of the Sandy Lake Health and Diabetes Project in northern Ontario, Canada.