Current models of diabetes care delivery fall short of producing excellent glycemic control, perhaps due to the brevity of clinical interaction. The goal of our Comprehensive Diabetes Improvement Program (CDIP) is to utilize the "downtime " between clinic visits. CDIP utilizes a structured telephone intervention (STI) delivered by a peer motivator (PM) to 5 fellow patients with diabetes at weekly intervals for 6 months. The STI focused on multimodality diabetes self-management, stressing the roles of monitoring, diabetes education, diet, exercise, and medication adherence. In this report, we present our initial experience with 24 diabetes patients (4 PMs and 20 motivatees). The patients' mean age was 51.9 6 2.2 yr, BMI 35.3 6 1.2 kg/m2, duration of diabetes 8.6 6 1.4 yr; 55% were African American. The control group comprised diabetes patients not receiving structured phone calls. Based on a targeted 24 phone calls in 6 months, the mean percent phone calls received by patients in the 4 PM groups (PM-1 to PM-4) were 81.9 6 3.7%, 75.0 6 3.8%, 70.8 6 4.5%, and 58.3 6 2.3%, respectively. In a questionnaire study, the subjects overwhelmingly agreed that weekly telephone calls from fellow diabetes patients were acceptable (92.9%), helpful (80%), or improved self-management behavior (93%). No subject indicated that the calls interfered with home life. The mean changes in HbA1c (%) in the 4 groups (PM-1 to PM-4) from baseline to 6 months were 0.46 (NS), 21.6 (p < .02), 21.2 (p = .02), and 20.13 (NS), respectively. The corresponding mean changes in weight (kg) were 0.58, 22.03, 22.02, and 2.7 kg, respectively. There was an inverse correlation between the percentage of phone calls received and the change in HbA1c (r = 2.372) or weight (r = 2.42). These results indicate that a structured patient-to-patient telephone intervention improves diabetes self-management activities, which translates into improved glycemic control.