Diabetes care in the US is less than optimal. Some authors have found that targeted patient letters are also an effective tool to improve outcomes when they are part of a comprehensive disease management plan. Local patient satisfaction surveys had revealed that many patients had sub‐optimal understanding of diabetes measures and of the importance of controlling these measures to reduce diabetic complications. We wondered if tailored patient letters and enclosed lab orders when due might increase patient awareness of diabetes measures and increase patient engagement.We hypothesized that the addition of targeted patient letters with enclosed lab orders to an ongoing performance improvement program would further improve diabetes care.