Exenatide is a new injectable medication for the treatment of hyperglycemia in type 2 diabetes. Due to limited information of exenatide use in Asians and Pacific Islanders (API), we retrospectively reviewed API patients' responses to exenatide treatment and compared the efficacy and safety of treatment to Caucasian patients. A total of 92 patients (70 API, 21 Caucasians, and 1 Hispanic) with type 2 diabetes were treated with exenatide. In all patients, there was a significant decrease in A1c level, BMI, and weight after 6 months of exenatide treatment (A1c from 8.63 +/- 1.46 to 8.23 +/- 1.46; P = 0.03, BMI from 34.54 +/- 7.07 to 32.14 +/- 6.41; P0.01, and weight from 215.24 +/- 52.04 to 202.50 +/- 49.90; P0.01 at 95% CI, N = 51). However, differences in mean change of A1c level, BMI, and weight between API and Caucasian patients were not observed at 3 and 6 months of treatment. Side effects and discontinuation of exenatide treatment between API and Caucasian patients were similar. In conclusion, exenatide is an effective anti-hyperglycemic agent in API patients with responses similar to that observed for Caucasian patients.