This article aims to provide an overview of the current situation in the Western Pacific Region as a prelude to the other articles in this supplememt. It emphasises that, while there is much diversity within this huge Region, there is a rising prevalence of diabetes throughout the Region from which few, if any, countries and areas are spared. This is strongly associated with the lifestyle changes which follow industralisation, mechanisation and massive urbanisation; for which evolutionary processes have left us metabolically ill-equipped. The current epidemic of diabetes is principally due to rises in Type 2 diabetes, although Type 1 diabetes prevalence rates are also rising. The Region already contains more than 30 million people with diabetes and the number is estimated to double by 2025. Diabetes prevalence rates already exceed 8% in 12 countries and areas within the Region. In the more impoverished parts of the Region the majority have little access to care and in all parts of the Region a substantial proportion remain undiagnosed. The increasing emergence of Type 2 diabetes in young adults and children gives particular cause for concern. There is an urgent need for targetted action at all levels within the Region.