The challenge of translating scientific knowledge into improved diabetes care in the 1990s

The problems associated with translating scientific knowledge into improved diabetes care are formidable but solvable. The American public has already made important changes in its health-related behavior. Millions of people have stopped smoking cigarettes, and many people have changed other behaviors to reduce their risk of cardiovascular disease and cancer. Many of the changes required to improve the quality of diabetes care in the 1990s will involve significant changes in our society's health-care policies and its health-related values and behaviors. Such changes, although often difficult to bring about, have the potential to have a profound and lasting impact on the health of our society. Many patients with diabetes have already implemented new care practices such as self-monitoring of blood glucose and multiple insulin injection regimens. As better technology and more evidence for the efficacy of rigorous blood glucose control become available, they will also be translated into practice. Diabetes care can be improved but to do so significant scientific and societal resources will have to be brought to bear on the problem of understanding and influencing the health-related behavior of people with diabetes and the health-care professionals and institutions providing care for them.