Two articles in this supplement describe the enormous health and economic burden posed by diabetes (7–8). Fortunately, several efficacious strategies to prevent or delay diabetes complications have emerged during the past decade, including control of blood pressure, lipids, and glycemia; early detection and treatment of diabetic retinopathy, nephropathy, and foot disease; therapy with aspirin and angiotensin-converting enzyme (ACE) inhibitors; and influenza and pneumococcal vaccines (1–2). Although many of these treatments are relatively cost-effective, their implementation remains suboptimal. According to national data, in the United States there is a considerable gap between recommended diabetes care and the care patients actually receive (4). In 1988–1995, for example, 18% of diabetic persons age 18 to 75 years had a hemoglobin A1c level greater than 9.5%, 34.3% were hypertensive (blood pressure ≥ 140/90 mm Hg), and 58% had a low-density lipoprotein cholesterol level of 3.35 mmol/L or greater (≥ 130 mg/dL). In addition, 63% had a dilated eye examination in the previous year, 54.8% had a foot examination; just 38% were self-monitoring their blood glucose levels; and only 46% and 27% had received influenza vaccine and pneumococcal vaccine, respectively. More recent data, however, indicate encouraging improvement, with increases in the use of eye examination (increased 7 percentage points), foot examination (6 percentage points), self-monitoring of blood glucose (15 percentage points), influenza vaccine (5 percentage points), and pneumococcal vaccine (15 percentage points) (9).