In order to better inform local management of TB-diabetes collaborative activities, we aimed to determine the prevalence of diabetes among persons with and without TB; and to determine the association between TB and diabetes in Kiribati, a Pacific Island nation. We compared consecutively enrolled TB cases to a group of randomly selected community controls without evidence of TB. Diabetes was diagnosed by HbA1c, and clinical and demographic data were collected. A tuberculin skin test was administered to controls. The chi-square test was used to assess significance in differences between cases and controls. We also calculated an odds ratio, with 95% confidence intervals, for the odds of diabetes among cases relative to controls. Unweighted multivariate logistic regression was performed to adjust for the effects of age and sex. A total of 275 TB cases and 499 controls were enrolled. The diabetes prevalence in cases (101, 37%), was significantly greater than in controls (94, 19%) (adjusted odds ratio: 2.8; 95% CI 2.0-4.1). 55% (108) of all diabetic diagnoses were new; this proportion was higher among controls (64.8%) than cases (46.5%). Five TB patients were screened to detect one patient with diabetes. There is a strong association between TB and diabetes in Kiribati and bi-directional screening should be conducted in this setting. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.