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Pacific Island countries lie in the region that is expected to experience among the greatest predicted increase in diabetes prevalence but have a limited capacity to address their ever increasing burden of diabetes and its consequences. This article describes the components and progress to date of a World Diabetes Foundation programme in Vanuatu which aims to reduce visual impairment, kidney disease and diabetes-related amputations. This secondary prevention project is by definition clinically based but, to achieve its aims, adopts a broader focus on the systems that underpin clinical care — training, workforce, clinical guidelines and protocols, information, equipment and supplies, and the organisation of care. The ‘recipe’ is simple: (i) measure the baseline situation, (ii) build the model — develop a locally relevant model to strengthen the diabetes care system and address the identified problems, (iii) make a difference — implement and refine the model, and (iv) measure the difference. The key strategy is local engagement to build Vanuatu's capacity for self-determination and sustainability in reducing the impact of diabetes on its people and its economy. Baseline assessment of the physical and financial impact of diabetes is nearing completion. Work on strengthening the diabetes care system is underway, clinical targets have been agreed and a clinical information system has been introduced. The willingness of the community to engage is evidenced by the recent establishment of a national diabetes association which is currently applying for membership of the International Diabetes Federation to join Vanuatu into the global diabetes community. Copyright © 2006 John Wiley & Sons.