Introductory remarks: diabetes care in America - "a sense of urgency"

To review the status of diabetes care in America and present questions to be addressed in the current consensus conference.

Data from recent studies are reviewed, and trends in diabetes care are summarized in an effort to improve interventional strategies and future results.

The diabetes epidemic is worsening; more than 20 million Americans have diabetes. Another 42 million Americans have pre-diabetes. Diabetes care in America has deteriorated during the past decade, with fewer patients at target hemoglobin A1c levels. New diabetes-related therapies and technologies are available, but clinicians often fail to intervene early and aggressively to achieve good glycemic control and help avoid complications. Moreover, many patients do not receive education and training in diabetes self-management. Several questions must be addressed in order to develop recommendations for implementing more aggressive treatment strategies in patients with diabetes.

Substantial clinical and financial benefits can be gained through better control of diabetes. Finding ways to meet this challenge must be a priority.