Our challenge is to change a cultural trajectory while still addressing immediate needs such as severe wounds that result in amputation. This goal requires education about diabetes and support in making lifestyle changes. Our unique approach is to partner with local doctors and nurses to improve quality of patient care. Our work with church congregations, schools, community gardens, as well as our suggestions for exercise and diet changes will provide the Tongan people with the tools to they need to return to healthier lifestyles of the past.