Diabetes mellitus is one of the most common chronic diseases affecting the elderly in the United States. It has been diagnosed in 9.6% of people 65 years of age and older, and an additional 9.3% meet oral glucose tolerance test criteria for the disease but have not been diagnosed. Taken together, diagnosed and undiagnosed diabetes affects almost one in every five people 65 years of age and older. An additional 23% of the elderly meet diagnostic criteria for impaired glucose tolerance, a condition that conveys excess risk for macrovascular disease. Prevalence of diagnosed diabetes in the elderly is expected to increase 44% in the next 20 years, to an estimated population of 3.9 million people. Elderly people with diabetes make an average of 3.7 visits per year to physicians specifically for care of their diabetes. Over 80% of this care is delivered by general and family physicians and internists. About 30% of diabetics 65 to 74 years of age are hospitalized each year, a rate that is almost twice that of elderly people without diabetes. Cardiovascular and peripheral vascular complications are often twice as prevalent as among people without diabetes. Risk factors for macrovascular disease are also highly prevalent among the elderly, including obesity, hypertension, and hypercholesterolemia. Three fourths of deaths of diabetic patients 65 years of age and older are caused by diseases of the circulatory system, primarily ischemic heart disease and stroke. The death rate from cardiovascular disease among elderly diabetic patients is twice that of people without diabetes in the same age range.