Diabetes is a chronic and, often, disabling disease, which has reached epidemic proportions in America and worldwide. When a person has diabetes their body cannot produce or properly use insulin – a hormone needed to convert sugar, starches, and other foods into energy. This leads to high levels of sugar in the bloodstream, which can result in serious complications and premature death, if diabetes is not controlled. There are three main types of diabetes [1]. In type 1 diabetes, the body does not produce any insulin; daily injections of insulin are required for survival. Typically beginning in childhood or young adulthood, type 1 accounts for approximately 5–10% of all cases of diabetes. Autoimmune, genetic, and environmental factors influence type 1 diabetes risk [1]. In type 2 diabetes, which accounts for 90–95% of all diagnosed cases, the body’s cells do not secrete or use insulin adequately. Risk factors for type 2 diabetes include obesity, physical inactivity, family history of diabetes, and history of gestational diabetes (GDM). GDM, defined as diabetes that develops or is first recognized during pregnancy, is the third type of diabetes. Risk factors for GDM include obesity, pregnancy weight gain, age, and family history of diabetes [1–5]. In the weeks after pregnancy, 5–10% of women who had GDM are diagnosed with type 2 diabetes [1]. Subsequently, women with a history of GDM have a 20–50% chance of developing type 2 diabetes five to 10 years after the index pregnancy, with a lifetime risk near 80% [1, 4–7]. Both type 2 diabetes and GDM are diagnosed more frequently in African Americans, Hispanic/Latino Americans, and American Indians compared to non-Hispanic whites [1]. National Health and Nutrition Examination Survey III data for nonpregnant women aged 20–49 years indicate that during the period 1988–1994, 27.6% of Mexican American women and 22.4% of African American women of childbearing age had diabetes or impaired glucose tolerance, in comparison to 10.1% of non-Hispanic white women [8]. Approximately one third of women of childbearing age have undiagnosed diabetes [9]. Additionally, between 3 and 8% of pregnant women have gestational diabetes (GDM) [2, 3, 9, 10]. A study of women with pregestational diabetes (type 1 and type 2) found that 60% of the women had suboptimal glucose control before conception [11]. Women who had a poor outcome in a previous pregnancy were more likely to enter a subsequent pregnancy with poor glucose control then were women with good outcomes [11]. Diabetes during pregnancy is associated with increased risk for miscarriages, stillbirth, macrosomia and obstetric complications [12–16], intrauterine developmental and growth abnormalities, birth and neonatal complications, and later development of obesity and type 2 diabetes [3, 10–15, 17, 18]. Treatment to normalize maternal blood glucose prior to conception and throughout pregnancy is necessary to reduce the likelihood of maternal, obstetric, and infant complications [12–16]. While treatment and monitoring are common practice during prenatal care, many women and their families may not know about the importance or even the existence of preconception care interventions for women of childbearing age who have or are at risk for diabetes. Greater awareness of the potential contribution of preconception care to diabetes prevention and control may help reduce the devastating impact of diabetes and its complications on the lives of women and their families. The objectives of this paper are to: 1) review barriers that can impede a woman’s ability to receive preconception care, and 2) recommend novel interventions to reach reproductive-aged women with or at risk for diabetes. Prevention trials have demonstrated that type 2 diabetes and its complications can be prevented or at least delayed through healthful dietary practices, regular moderate physical activity, weight loss, and medication use [19, 20]. The clinical practice guidelines of the American College of Obstetrics and Gynecologists [21] and the American Diabetes Association [15] suggest that preconception care is an ideal primary prevention opportunity during which modifiable risk factors can be identified and reduced. Preconception care may be defined as a window of opportunity for comprehensive health care to: 1) identify conditions that may have detrimental effects on the mother or fetus, and 2) recommend necessary medical, behavioral, and educational interventions for increasing the likelihood of achieving optimal pregnancy outcomes. A major goal of preconception care for women with diabetes is to reduce the risk of diabetes-related complications by obtaining the lowest possible glycated hemoglobin (HbA1C [a measure of glucose control]) without significant episodes of hypoglycemia [15]. Women with diabetes who receive preconception care obtain intensive treatment to assist them with developing diabetes self-management skills, and obtaining nutritional, physical activity, and medical support needed to promote optimal glucose control and health status before becoming pregnant. During interconception periods, diabetes education, postpartum glucose testing, and ongoing support to reduce postpartum weight retention and maintain a healthy weight and glucose control may also help reduce risk factors for subsequent morbidity [3, 19, 24]. Previous studies have found that women with diabetes who received preconception care demonstrated improved glucose control during pregnancy, their offspring had fewer congenital anomalies, and the women’s hospital stays were shorter in comparison with women who did not receive preconception care [25–27]. Although these findings are very positive and they support the importance of preconception care for women with diabetes, other studies have indicated that many women who could benefit from preconception care are not receiving this intervention [25, 28]. Barriers to receiving preconception care At every health care encounter, a woman of childbearing age should be informed about the importance of preconception care and, if she has diabetes, the steps required to maintain appropriate blood glucose control [15, 28, 29]. Unfortunately, however, reaching women who may be in need of preconception care has proven to be difficult, with only a quarter to a third of women with diagnosed diabetes receiving this care [25, 28]. There are many barriers to providing and/or receiving preconception care. Among them are: 1) Many women with diabetes do not know that they have the illness and, thus, they are undiagnosed [1], 2) Approximately 50% of all pregnancies are unintended [28, 30, 31], 3) Even among women planning to become pregnant, lack of health insurance or a regular care primary care or obstetric provider reduces contact with the health care system [32–34], 4) Many primary care practices do not have or use established guidelines for providing preconception care, or identifying women with risk factors [32, 34], 5) Some women and health care providers may not know about about the existence or the importance of preconception care or do not see it as a high priority [15, 32, 34, 35], and 6) Women with incomplete health care coverage, lack of child care or transportation, geographic isolation, distrust of health care providers or other social and economic challenges have additional barriers to receiving preconception care [15, 32, 34–36]. Women are more likely to receive preconception care if they are married or in a stable relationship, are comparatively older, are nonsmokers, are non-Hispanic whites, are more educated, have annual incomes above $20,000, have private medical insurance, and have a positive bond with their prepregnancy care provider [25, 26, 28, 33, 35]. Younger women with diabetes and those who are single, have low income, or are less educated may be particularly vulnerable to unplanned pregnancies, which greatly reduces the chances that they will receive any form of diabetes-related preconception counseling [16, 32, 36].