BACKGROUND: We evaluated the association between coffee drinking and the prevalence of type 2 diabetes mellitus in elderly people from the Mediterranean islands. METHODS: During 2005-2007, 500 men and 437 women (aged 65 to 100 years) from the islands of Cyprus (n = 300), Mitilini (n = 142), Samothraki (n = 100), Cephalonia (n = 104), Corfu (n = 160) and Crete (n = 131) participated in the survey. Cardiovascular disease (CVD) risk factors (i.e. hypertension, diabetes, hypercholesterolemia and obesity), as well as behavioral, lifestyle and dietary characteristics were assessed using face-to-face interviews and standard procedures. Among various factors, fasting blood glucose was measured and prevalence of type 2 diabetes mellitus was estimated, according to the established American Diabetes Association (ADA) criteria, while all participants were asked about the frequency of any type of coffee consumption over the last year. RESULTS: Coffee drinking was reported by 84% of the participants, the majority of whom drank boiled coffee. The participants reported that they had consumed coffee for at least 30 years of their life. Data analysis adjusted for various potential confounders, revealed that, compared to non-consumption, the multi-adjusted odds ratio for having diabetes was 0.47 (95%, CI 0.32 to 0.69) for 1- 2 cups/day, while it was 1.05 (95%, CI 0.70 to 1.55) for >3 cups/day, after adjusting for various potential confounders. The association of coffee drinking with diabetes was significant only among non-tea drinkers. Increased coffee intake was not associated with diabetes prevalence. CONCLUSION: The data presented suggest that moderate coffee drinking is associated with a lower likelihood of having diabetes, after adjusting for various potential confounders.