Reprint requests may be sentto The liabetes Educator, 367 West Chicago Avenue, Chicago, lI. 606 10-3025. from the SAGE Social Science Collections. All Rights Reserved. revalence estimates in-dicate that about 15.5 million people were affected by diabetes in 1993 and approximately 1 in 8 are at risk of developing the disease." Based on information from death certifi-cates, diabetes is one of the leading causes of death in the United States. In 1993 there were more than

385 000 deaths among people with diabetes aged 25 and older. The so-cial and economic costs of diabetes are high.** Direct and indirect medical costs resulting from diabetes-related complications were calculated to be $92 billion; 40% of this amount was spent on hospital care. Given the prevalence and impact of diabetes on the national public health system, there is increasing interest in studying the factors that enhance self-care and serve as a buffer from the corrosive effects of diabetes on the systems of the body." Implications from the Diabetes Control and Complications Trial (DCCT)"" are that main-taining blood glucose at near-normal levels can delay the onset of diabetes complications such as retinopathy, nephropathy, and neuropathy.

A fundamental component of maintaining near-normal blood glucose levels is self-management. Lifestyle behaviors that promote adherence to the prescribed rigors of diabetes management can serve to mitigate the deleterious effects of the disease.*" Simply knowing that selfmanagement is integral to effective