A high proportion of patients with cystic fibrosis (CF) develop diabetes mellitus. In common with type II diabetes mellitus, diabetes mellitus in CF is characterized by a progressive decline in beta-cell function and an approximately 50% decline in beta-cell mass. It is not known whether islet amyloidosis (characteristic of type II diabetes mellitus) is present in diabetes mellitus complicating CF. To address this, pancreatic samples were obtained at autopsy from 9 control cases (without CF) and 41 cases of CF that were, in turn, subdivided into 13 nondiabetic, 12 borderline diabetic, and 16 diabetic cases based on clinical criteria. Islet amyloid was detected by light microscopy in 69% cases of CF with diabetes mellitus, 17% of cases with borderline diabetes mellitus, and none of the nondiabetic cases. Islet amyloid was not present in any of the control cases. Islet amyloidosis derived from islet amyloid polypeptide is a characteristic feature of diabetes mellitus in CF as well as type II diabetes mellitus.