This paper describes the methods used to develop and evaluate diabetes education material for American Indians and Alaska Natives living in Washington, Oregon, and Idaho. Reading skills of individuals and readability of a sample of existing diabetic education material were measured. Using the Wide Range Achievement Test to measure reading skills, the authors found that 66% of the sample read at a 5th "grade" or higher level. Readability of a sample of available diabetic education material was found to be, on average, at the 10th "grade" level. Diabetes education booklets targeted to a 5th to 7th "grade" level were developed and assessed for acceptability and comprehension. Final evaluation, using the close procedure, showed that 62% of the target audience understood the messages in the booklets. A comprehensive assessment process was found to be useful in developing effective diabetes education material for Indian communities.