diabetes is the sixth leading cause of death in the united states and affects approximately 7% of the population (hupke, camp, chaufoumier, langley, & little, 2004; piatt et al., 2006). it is an established fact that the long-term complications of diabetes can be reduced by tight glycemic control. there is a clear relationship between control of blood glucose, blood pressure, and lipid level, and the ability to decrease microvascular and macrovascular morbidity (nutting et al., 2007). a common measure of blood sugar control is that of glycosylated hemoglobin, or hbalc. this laboratory test provides a measure of blood sugar control over the previous 3 months (canadian diabetes association [cda], 2007). a cochrane collaboration review reported that an average reduction of hba1c of 1% or more can result in a 21% reduction in mortality, a 14% reduction in acute myocardial infarction (ami) , and a 37% reduction in microvascular complications if sustained over time (as cited in wagner, austin, et al., 2001). there is, however, a gap between this evidence and what is achieved in clinical practice (nutting et al., 2007). wagner, austin, et al. (2001) argued that fewer than half of patients in the united states with diabetes are receiving proper treatment. a primary care management study of type 2 diabetes reported that 47.5% of patients had at least one diabetes-related complication (spann et al., 2006). over half of the patients (60.8%) in this study had a body mass index greater than 30 and a mean hbalc of 7.6%; 35.3% had adequate blood pressure control; and 43.7% had adequate low-density lipoprotein (ldl) cholesterol levels.