Although the primary care office is an important location for integrating new advances in the treatment of diabetes, the current delivery of preventive primary care for patients with diabetes falls short of clinical recommendations. Barriers within the existing health care system, practice structure, and physician and patient support services are among the most commonly cited obstacles to initiating better preventive care. As public health groups demand greater accountability from the medical system, regulatory efforts focus more scrutiny on systems, clinic practices, and even individual physician practices. Although improving care delivery effectively and efficiently is difficult, strategies to exist that can increase the likelihood of improving patient outcomes. Successful diabetes initiatives are often characterized by the consensual adoption of an evidence-based treatment plan. Effective physician-oriented interventions include the use of reminder systems, local opinion leaders, and academic detailing. In addition, several national diabetes initiatives are likely to influence primary care practice. New measures of accountability will be widely used to determine the quality of primary diabetes care delivery.