Diabetes is a serious chronic disease. It is the fourth leading cause of death by disease and is the leading cause of blindness in people between the ages of 20 and 74 years. Diabetes is responsible for over one-third of patients on dialysis, and accounts for over half of all nontraumatic lower extremity amputations. It doubles the risk of stroke and increases the chances for a heart attack 2-fold in men and 4- to 5-fold in women.Sadly, much of these devastating complications need not happen if only certain evidence-based outcome and performance measures for good diabetes care are followed. Ten of these are presented and discussed. Some are quantitative outcomes (glycaemia, lipids, renal evaluation and blood pressure) and the evidence for each is summarised. If these outcomes are not achieved, additional action is required, an approach not included in previous promulgations of guidelines for diabetes care. Others are process measures so closely linked to outcomes that few could argue about their importance are presented as surrogate end-points (office visits, eye and foot examinations, measurement of weight and assessment of smoking).The establishment of a Provider Recognition Program by the American Diabetes Association as an inducement for physicians to improve their level of diabetes care is described. The recent cosponsorship of this programme by the National Committee of Quality Assurance, the accrediting body of health maintenance organisations, is likely to play a major role in the improvement of diabetes care in managed care organisations.