Diabetes presents a host of management issues to the practitioner. With the increasing role of managed care systems, the care of diabetic patients has created many issues in the relationship of physicians and third-party reimbursement agencies. We predict a progressive evolution of diabetes care in light of these changes. The diabetic population will continue to grow rapidly. Collaborative care systems will expand. The paper medical record will be replaced by electronic documentation. The technology of diabetes care will progress rapidly in providing office and home care for diabetes patients. The increasing cost of these interventions and the growing diabetic population will challenge the reimbursement system. We will have to seek for more cost-effective approaches in light of these factors.