Diabetes mellitus is a chronic disease of major global health concern due to its increasing prevalence in both developing and developed counties, with a projection increase of 214% from the year 2000 to 2030. Among the Aboriginal population of Canada (which includes the First Nations, Inuit and Metis), diabetes mellitus contribute significantly to their higher morbidity and increased health disparity when compared to the non-Aboriginal Canadians. In view of this, the Federal Government of Canada had launched the Aboriginal Diabetes Initiative (ADI) in 1999 as part of the bigger Canadian Diabetes Strategy to provide a better framework for surveillance, public education and community-based management of diabetes. Originally, ADI was intended for a 5-year cycle, but it was renewed twice in 2005 and then 2010, with a total funding of C$523 million. Given its long history of operation and the massive amount of revenue being injected, it is worthwhile to review the background information and the relevant data that had fostered the ADI; and more importantly, to critically evaluate the benefits and impact of the ADI in terms of the actual health of the Aboriginals and their social inequalities.