This study was conducted to identify the Type 2 diabetes mellitus (T2DM) health beliefs, biomedical knowledge, health care utilization and management practices among a Tz'utujil Maya population, and examine whether these overlap with the reported T2DM health beliefs and behaviors reported in the current "Latino" health beliefs literature. A convenience sample of Tz'utujil Maya adults previously diagnosed with T2DM residing in the town of Santiago Atitlan was recruited through various health care institutions and chain referrals. The study was conducted in two phases. A semi-structured interview (n = 10) based on Kleinman's Explanatory Model framework was conducted in the first phase. Results informed the tailoring of the ECSDA questionnaire used in Phase 2 (n = 99) which examined the T2DM health beliefs, biomedical knowledge, and health behaviors. Phase 1 data were analyzed using thematic analysis methodology, while Phase 2 data were analyzed using SPSS descriptive statistics. Study results demonstrated that while there is some overlap on T2DM causative and curative beliefs among the ECSDA study participants and the larger "Latino" health beliefs reported in the literature, there are also key differences which require further evaluation to truly capture the local diabetes explanatory model. Additionally, this population is receptive to health providers' treatment recommendations including taking prescribed medications and attempting recommended behavior modifications. However, a major barrier to diabetes management was cost, as half of the participants reported having difficulty purchasing prescribed medications. Finally, despite low scores on theT2DM biomedical knowledge scale, this population understands the importance of managing this condition. This population functions within a pluralistic health system in which they maintain cultural-related explanations of diabetes causation, while demonstrating a trust and preference for biomedical treatment for this condition. A community-based participatory action research (PAR) approach that is inclusive of the local resident's health beliefs, social norms, and recommendations for management strategies, would best inform the development of future T2DM management programs.