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Background: The prevalence of diabetes is unusually high among the indigenous peoples of Hawaii and the US-associated Pacific Islands. Although diabetes programs developed elsewhere have been tried in these Pacific Islander communities, they have not been sustained. Research suggests that program sustainability is enhanced by the presence of a champion, the fit of the program in an organization, and assistance from stakeholders., Context: In 1998, the Pacific Diabetes Today Resource Center, funded by the Centers for Disease Control and Prevention, applied a community-empowerment approach to diabetes programming, providing training and technical assistance to coalitions in 11 US-associated Pacific Islands communities. When funding ended in 2004, many of the diabetes programs continued. In 2008, we revisited the 11 communities to examine the vitality of their diabetes coalitions and factors that were known to sustain the programs., Methods: We interviewed coalition representatives in each of the 11 communities about diabetes-related programming developed from 1999 through 2003 and factors influencing sustainability of diabetes-related activities., Consequences: Coalitions that continued the diabetes programming they developed for or adapted to their communities had community leaders (or champions), found supportive organizational homes for the programs, and had assistance. Four case studies show how these factors affected successful coalitions., Interpretation: Freedom to adapt programs to new cultural contexts was a key factor in sustaining diabetes programs in the region.

Background: The type 2 diabetes epidemic is a global health issue, particularly in the US Associated Pacific Islands (USAPI). Population health approaches targeting policy development and environmental transformations can help prevent or delay diabetes and related complications., Context: Since 1986, the Centers for Disease Control and Prevention, Division of Diabetes Translation has provided financial support to 6 USAPI jurisdictions for diabetes prevention and control programs. Geographic isolation, shortages of health care professionals, dependence on US and international aid, and persistent health care funding challenges are constant concerns in these jurisdictions., Methods: In September 2007, representatives from USAPI diabetes prevention and control programs, the Papa Ola Lökahi Pacific Diabetes Education Program, and the Division of Diabetes Translation met to collectively assess program goals within the Essential Public Health Services framework. Participants shared examples of integrated approaches to health promotion and diabetes prevention., Consequences: Despite persistent health care funding challenges, the assessment showed the resourcefulness of the islands' diabetes programs in leveraging resources, creating policy and environmental interventions, and strengthening connections in the traditional cultural systems., Interpretation: Population health approaches used in island jurisdictions reflect the resilience of the islands' cultures in navigating between traditional and Western ways of life. Attention to the interface of cultural knowledge and Western science provides the USAPI diabetes prevention and control programs with opportunities to create strong, sustained partnerships with the shared vision of transforming social and environmental conditions so that they can support healthy people living in healthy island communities.