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Newer management strategies to intensify diabetes care have been shown to decrease the risk of microvascular complications and reduce acute diabetes related morbidity. These strategies reduce both the short term and the long term costs of diabetes care, and improve the quality of life for those affected by diabetes. However, the current U.S. health-care structure does not adequately provide reimbursement for the multidisciplinary team required to implement and maintain modern intensified diabetes management. We present data supporting the cost of providing this care to pediatric patients and suggest that this care is cost effective. Strategies for appropriate reimbursement are presented, but further work is needed to implement the disease management approach to diabetes care.