In the past five years, there has been a surge in the attention shown to community and community-based health programs among Native Americans, particularly for chronic health problems such as diabetes. Community participation in health programming--from the efforts of community health workers (CHWs), to participatory research, to the impact of politics on community health programs--has been a popular approach in anthropology and public health since the late 1970s and is now a hackneyed expression in health programming. In this article, the author aims to consider the resurgence of community-based programs in Native American communities in the United States and to explore in particular the meanings, benefits, and potential dangers of this trendy model in diabetes programming. As community participation has been considered thoroughly before, the author has focused her attention on its recent popularity for diabetes treatment and education. The author begins with a historical overview of the objectives of community participation as it has grown out of the first agriculture extension and international development projects into medical anthropology and particularly public health practice. She then considers the fundamental aspects of community participation. These fundamentals organize her analysis of community participation in Native American communities and point to the inadequate transformation of the social and economic structures that sustain high prevalence and incidence of diabetes in these groups. As a case study, the author draws upon ongoing fieldwork in the Gila River Indian community. Undergoing a transition from crisis to epidemic (or disproportionately large) rates and finally to endemic rates of diabetes (in which diabetes is characteristic among a population), the Gila River Indian community demonstrates an evolution of disease interventions. This evolution has involved a predictable progression in the community's reaction to widespread disease, including relatively late attention to structural barriers and the need for community-based approaches. The author then concludes by exploring the possibilities for the culturally transformative and structural changes that might produce the elusive reduction in diabetes prevalence for Native Americans. (Contains 2 tables and 101 notes.)