Diabetes is approaching epidemic proportions among Pacific people both in their traditional homelands as well as in metropolitan centres of their newly adopted Western countries. Although the risk factors associated with diabetes among individuals are reasonably well understood, the "upstream" causes needs to be critically appraised. While individual interventions and health education has its role, there is an urgent need to intervene at the upstream causes of diabetes and other ill health including social, trade, economic and political at the population, state and international level. Attempts to control diabetes in a vacuum without reference to socioeconomic and political context is a convenient vehicle that has contributed to and will continue to fuel calories to the diabetes epidemic.