This guide (the National Institutes of Health Publication 11-7739) is designed to help health care professionals and health care organizations implement collaborative, multidisciplinary team care for adults and children with diabetes in a variety of settings. Collaborative teams that provide continuous, supportive, and effective care for people with diabetes throughout the course of their disease are a model for the prevention and management of chronic diseases. Well-implemented diabetes team care can be cost-effective and the preferred method of care delivery, particularly when services include health promotion and disease prevention, in addition to inten-sive clinical management. Team care is a key component of health care reform initiatives that incorporate an inte-grated health care delivery system, especially those for chronic disease prevention and management. Diabetes is a serious, common, and costly disease that affects 25.8 million Americans, or 8.3 percent of the U.S. population. About 90 to 95 percent of people with diabetes have type 2, which usually occurs in adults over age 45 but is increasingly occurring in younger age groups. Type 1 is usually diagnosed during childhood, although adults can also develop the disease. Some patients may have features of both type 1 and type 2 diabetes, which further complicates disease treatment and management. In addition, at least 79 million U.S. adults have pre-diabetes, which places them at increased risk for cardiovascular disease and type 2 diabetes. The chronic complications of diabetes (cardiovascular disease, vision loss, kidney failure, nerve damage, and lower-extremity amputations) result in higher rates of disability, increased use of health care services, lost days from work, unem-ployment, decreased quality of life, and premature mortality. Acute complications can also result in lost days from school. To achieve the health benefits that modern science has made possible, the principal clinical features of diabetes-hyperglycemia, dyslipidemia, and hypertension-need to be prevented and managed within a system that provides continuous, proactive, planned, patient-centered, and population-based care. Primary care physicians, physician assistants, and nurse practitioners all play important roles in the delivery of primary care for people with chronic diseases in the United States. To reduce the risk of microvascular complications, this care needs to include regular assessment of the eyes, kidneys, teeth and mouth, and lower extremities in people with diabetes. System constraints, however, can make it difficult for primary care providers to carry out all of these essential elements of comprehensive diabetes care. Team care can minimize patients' health risks by assessment, intervention, and surveillance to identify problems early and initiate timely treatment. Increased use of effective behavioral interventions to lower the risk of diabetes and treatments to improve glycemic control and cardiovascular risk profiles can prevent or delay progression to kidney failure, vision loss, nerve damage, lower-extremity amputation, and cardiovascular disease. Patients' participation in treatment decisions, personal selection of behavioral goals, patient education and training, and active self-management can improve diabetes control. This in turn leads to increased patient satisfaction with care, better quality of life, improved health outcomes, and ultimately, lower health care costs. Collaborative teams vary according to patients' needs, patient load, organizational constraints, resources, clinical setting, geographic location, and professional skills. It is essential that a key person coordinate the team effort. The resources and support of community partners such as school nurses, community health workers, trained peer leaders, and others can augment clinical care teams."