Differences in pathophysiology may affect the diagnosis, prevention, and treatment of diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs). Equally important are differences in cultural beliefs, dietary habits, and behavioral patterns among AANHPIs that require culturally effective translation of interventions into the community. These issues were discussed by clinicians and investigators at a conference held in Honolulu, Hawaii, in September 2011 with the theme “Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders: A Call to Action” by a coalition of health care organizations, clinicians, and scientists with strong interests in the topic and in the health of AANHPI populations (1). The discourse begins with an evaluation of pathophysiologic differences, followed by a discussion of the standard diagnostic criteria and current treatment algorithms as well as dietary recommendations. The focus then shifts to various diabetes prevention studies specific to AANHPIs and their relevance to this growing ethnic minority group in America. This review concludes with two investigations that demonstrate culturally appropriate interventions and a brief description of the role played by the National Diabetes Education Program (NDEP). ### Pathophysiology—type 1 diabetes Diabetes has reached an epidemic level around the world, with most of the increase attributable to type 2 diabetes in developing Asian countries such as India and China (2). Type 1 diabetes is also increasing, although at a much less dramatic rate than type 2 diabetes and is now also increasingly associated with obesity and insulin resistance (3). The highest rates for type 1 diabetes are found in Northern European and Scandinavian countries and among the Caucasian population of the U.S. In contrast, type 1 diabetes is approximately 5 to 10 times lower in prevalence in those of Asian than those of European descent (4). In the U.S., the incidence of type 1 diabetes is lower by two- to fivefold in …