This qualitative research focuses on understanding the experiences of elderly patients with diabetes who participated in a telemedicine case management intervention, to better understand the barriers to success of telemedicine with the elderly. Telephone interviews were conducted with elderly patients with diabetes prior to and 6 and 12 months after participating in a case management intervention delivered via a computer that allowed them to teleconference with a nurse and dietitian, upload blood glucose and blood pressure data, and access educational materials. Qualitative analyses revealed that patients enrolled primarily because healthcare providers encouraged them. Their goals were to improve diabetes control, with few expectations of an effect on emotional health or family relationships. After involvement, they particularly valued the emphasis on monitoring of health outcomes and supportive contact with diabetes staff to encourage, remind, and answer questions. Findings illustrate the potential value of telemedicine with elderly patients with diabetes, if supported by primary care providers and including consistent, supportive interactions with knowledgeable diabetes healthcare providers.