Diabetes mellitus (DM) is a growing epidemic in the U.S. associated with significant costs, reduced quality of life, long-term complications, and high rates of morbidity and mortality. Purpose: Determine the rate of compliance in hospitalized patients with the American Diabetes Association (ADA) monitoring and treatment guidelines for DM regarding: glucose management, cholesterol management, stroke prevention, ACE-I/ARB utilization, and pneumococcal vaccination (PPV). Setting: 760-bed, tertiary-care teaching hospital. Methods: This retrospective chart review evaluated all adult, hospitalized patients with a diagnosis code for DM who were consecutively discharged from a general medical unit, beginning 4/1/06 until data on 100 patients were collected. Patients with gestational diabetes, hospital admission < 3days, or death prior to discharge were excluded. The following measurements were collected: blood glucose, cholesterol management, stroke prevention, ACE-I/ARB utilization, and PPV immunization. Results: Of the 100 patients reviewed, 96% had Type II DM; 24% had contraindications to at least one of their prescribed oral DM medications. Only 57% had HgA1c documented; of these, 56% were at goal. Only 42% had LDL cholesterol documented; of these, 76% were at goal. Appropriate stroke prevention was prescribed for 75% of patients; 70% were receiving appropriate ACE-I therapy; and 38% of eligible patients received PPV. Conclusion: A high percentage of hospitalized patients are not in full compliance with the ADA monitoring and treatment guidelines.