Diabetes is a major public health problem in the United States.  It affects over 13 million people and is disproportionately more common in the elderly, women, Blacks, Latinos and Native Americans.  Diabetes and its complications are responsible for over $20 billion in medical expenses annually.  The Diabetes Control and Complications Trial (DCCT) convincingly demonstrated that metabolic control will reduce markedly the microvascular complications of diabetes.  There will be increasing emphasis on intensive management and other strategies for the prevention of the chronic complications of diabetes as the implications of these results become incorporated into practice.  Whereas this study was conducted in patients with IDDM, the vast majority of patients with diabetes, even those on insulin have NIDDM.  The pathophysiology of microvascular complications in both types of diabetes is the same, but the specifics of applying intensive management in NIDDM have not been defined.  This includes the risk/benefit ratio in older patients and those with advanced micro- or macrovascular disease.  Additionally, there is a variety of potential strategies for the implementation of intensive management.  In the United States, 80% of children and 90% of adults with diabetes are cared for by primary care physicians.  Only hypertension is responsible for more outpatient visits to Internists.  The current emphasis of health care reform on primary care (gatekeeper) physicians suggest that such practitioners will continue to care for most patients with diabetes and, in fact, their role is likely to expand.  We need to define what recommendations we should make regarding intensive management in NIDDM and what policy changes that recommendations will necessitate.  In order to be able to accomplish this, we need a conference at which those involved in research and in clinical care for diabetes can discuss our current state of knowledge regarding the risks and benefits of intensive management of NIDDM.  In order for these recommendations to be of value, we need to include individuals in primary care and representatives from women's and minority groups who are greatly affected by NIDDM.  A second reason to hold the conference is to assist the NIH in defining the unanswered research questions regarding the risk and benefits of intensive management in NIDDM.  Finally, the conference will define the barriers in the health care system for the appropriate implementation of intensive management.  A major effort will be made to assure participation in this conference by individual minorities and women and also representatives of their organization (e.g., the National Medical Association) and travel funding to assist in their attendance is specifically requested in the budget.  It is anticipated that the NIDDK staff will play a major role in the development of the conference and that the conference proceedings will be published in a major peer-reviewed medical journal.