The prevalence of diabetes has increased consistently throughout recent decades. Among patients, 70.7% are aware of their disease, and 63% receive treatment. However, less than 20% of those treated maintain their blood sugar level (glycosylated hemoglobin > 6.5%), indicating that most diabetic patients do not receive appropriate treatment. Diabetes management requires consistent treatment and self-management, but elderly patients who lack social or family support and patients from socially disadvantaged classes tend to have less access to medical care and often stop treatment due to economic hardship. While public health centers, Diabetes registration and management center and home nursing services are available to support vulnerable diabetic patients, many are still neglected by our health care system. To improve patient quality of life, a free service providing information and consistent care based on community should be established. Also, when diabetic education team, patients, and their family's, community organizations connection is firmly formation, in the community can be used to effectively manage diabetes.