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Reported elsewhere in this issue is an analysis by the Division of Diabetes Translation (a component of the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services) of follow-up data linked to National Health Interview Surveys noting that, in both sexes, American adults with diabetes surveyed between 1997 and 2006 had a substantial decline in absolute mortality rate compared with nondiabetic adults (1). The authors caution that this favorable news may be modulated by a future rise in diabetes prevalence should diabetes incidence not be “curtailed.” Inferred from this study is affirmation of two main current strategic clinical goals to cope with pandemic diabetes: 1 ) reduction of the rate of new-onset diabetes and 2 ) interdiction of potentially fatal complications in individuals with diagnosed diabetes.Intervention to modify lifestyle has been termed “the most important single action to prevent type 2 diabetes mellitus” (2). As advocated by the International Diabetes Federation, as much as 80% of new-onset diabetes may be preventable by combining increased physical activity, weight loss, and reduced consumption of sugar and saturated fat (3). Modifying lifestyle to include eating five or more fruits and vegetables daily, regular exercise, no more than moderate alcohol consumption, and not smoking tobacco, sharply reduced the risk of all-cause mortality in 11,761 adult men and women participating in the National Health and Nutrition Examination Survey III (4). A major problem in attempting to sustain lifestyle changes, however, is that without continuous medical team support and encouragement, adherence to a healthy lifestyle pattern was noted to decrease over an 18-year period of surveillance, with documented reduction in practice of three of five healthy lifestyle habits (5). Fradkin (6) recently assessed contemporary diabetes management, finding it to be “suboptimal, particularly in …

Optimizing Care in Diabetes: a Quixotic Challenge