American Indians lived healthy, balanced lifestyles for thousands of years before they were displaced to reservations. Reservation lands were typically not suitable for sustaining their traditional healthy lifestyles, which involved hunting, gathering, fishing and farming. Many diseases including diabetes were unknown until the 1950s. Nowadays, however, diabetes and its complications are major contributors to death and disability in every Tribal community. The growing epidemic of diabetes threatens populations around the world, and the American Indian and Alaska Native population has been hit particularly hard. The authors report on a successful initiative that blends a conventional medical approach to diabetes prevention with centuries-old traditional practices.