Pacific peoples are disproportionately affected by type 2 diabetes (T2D) in Aotearoa New Zealand (ANZ). However, little is known about the burden of disease in different Pacific ethnic groups. Thus, this study aims to explore T2D characteristics and medication use in different island groups of Pacific individuals in ANZ. Primary care clinical and demographic data was collected for Pacific patients with T2D aged ≥ 18 years from primary health organisations across Auckland and Waikato (n = 302 practices; February 2021 – July 2022). Most recent clinical measures (HbA1c, cholesterol, blood pressure) and diabetes medication use were recorded and compared between ethnic groups. Data was available for 10,414 Pacific patients, including 4031 Samoan, 2033 Tongan, 1513 Cook Island Māori, 1463 Fijian, 797 Niuean and 98 Tokelauan adults. HbA1c levels were highest in Tongan patients and lowest in Fijian patients (P < 0.001 vs other groups); and Cook Island Māori and Samoan patients had a higher proportion of patients with cardiovascular/renal disease than other ethnic groups. Metformin use was comparable across ethnic groups, but SGLT2i/GLP1RA prescribing was lowest in Fijian patients (36.6% vs 39.9%-48.8%; P < 0.001). The use of medications for cholesterol and blood pressure were comparable across groups. The study finds that there are distinct differences in the characteristics and medication use of Pacific patients with T2D. Care must be taken to not always review Pacific people as a collective group, but rather to explore their clinical and demographical differences with the aim of tailoring care to each ethnic group as required.