Diabetes mellitus continues to increase in both new and total cases, not only in the United States but throughout the world.^{1, 2} Because of the increase in the number of persons with diabetes and the earlier onset of both type 1 and type 2 diabetes in many populations, concern is growing about the possibility of substantial increases in diabetes-related complications.³ The increases in the number of persons with diabetes mellitus could potentially overwhelm existing health care systems. Accordingly, the translation of emerging diabetes management research results into clinical practice needs to be expedited. This strategy must be complemented by a greater emphasis on primary prevention of diabetes.

Opportunities to reduce the health and economic burden of diabetes during the course of the disease are primarily located at four transition points. The first transition point is primary prevention, which, when successful, stops the development of diabetes. Screening/early diagnosis, when a patient moves from unrecognized to recognized diabetes, is the second transition point. Access to care presents the third transition point when the receipt of diabetes-specific care commences. Finally, improved quality of care moves from inadequate care to the standard of care.

Progress has been mixed for these four transition points in recent years. Greater progress in each of these four transition points will be one of the most effective methods for ensuring further improvement in quality of life and elimination of disparities. Quality of care, the fourth transition point, is improving.^{4, 5} Because fewer people in the United States possess health insurance,^{6, 7} access to care for persons with diabetes mellitus is worsening.^{8, 9} The second transition point, early diagnosis, is being supported by greater knowledge and efforts such as the Diabetes Detection Initiative,¹⁰ which combines public health strategies with health marketing and health communication techniques to improve risk assessment.¹¹ Finally, important scientific and economic evidence supports the critical nature of primary prevention, the first transition point.^{12, 13}

Preventive behaviors—among persons with diabetes mellitus and their health providers—are increasing. The degree to which preventive behaviors and both intermediate- and long-term outcomes have improved varies by objective.¹⁴ Despite advances in care, several issues regarding continued progress must be addressed. First, the majority of progress may have occurred with "early adopters"—that segment of a population that includes opinion leaders and experimenters who are critical to the spread of innovation. Subsequent positive movement may require new strategies.¹⁵