Diabetes is a chronic disease with consequences on both the individual and national
levels. It decreases life expectancy by seven years on average and can lead to serious
morbidities such as retinopathy, nephropathy, neuropathies and heart disease that
influence quality of life (Backlund et al., 1997; Romm and Hulka, 1979; Lippert et al.,
1995; Boulton, 1998; Turner et al., 1998). On the national level, the complexity of
diabetes and its synergy with other co-morbidities such as hypertension and
hypercholesterolemia, imposes a burden on health resources and interferes with
national productivity outcomes (Overland et al., 2000). In 1996, Clalit Health Services, a major Health Maintenance Organization (HMO) that provides care for 70 percent of Israel’s diabetes patients, initiated a program to improve diabetes care, with the
aim of addressing these problems and achieving effective control of diabetes within the