Diabetes prevalence and complications rates were examined for the indigenous population of the Commonwealth of the Northern Mariana Islands in the western Pacific. Diabetes is common, with 4% of the population and 11% of adults having diagnosed diabetes. Diabetes is more common among females and islanders of Carolinian descent. End stage renal disease, hospitalizations for pneumonia, non-traumatic lower extremity amputations and retinopathy are more common than expected (with relative risks of 3.9, 3.0, 1.5 and 1.3, respectively, compared with diabetics in US), while diabetes-related mortality and hospitalizations for ischemic heart disease/cerebrovascular disease are less (with relative risks of 0.9 and 0.8). Implications for primary and secondary prevention of diabetes and its complications are discussed.