Market level transformations occurring within the United States health care management environment and the increasing emphasis on global health requires new and creative models for organisation, management, reimbursement and service (Cogswell et al., 1997). These newly created paradigms in decision-making and innovative management strategies will become stabilising forces in the new millennium. A variety of current internal and external organisational factors and characteristics both support and hinder paradigm changes in decision-making models for health care management for chronic diseases at national and international levels. Political astuteness, global environment, resource allocations, cognitive, behavioural and cultural patterns of health care providers and choice of decision support models are facilitators as well as barriers to paradigm changes. Current decision support models for chronic diseases such as diabetes, utilised for health policy decisions, are based upon assumptions that may no longer be valid and reliable nor the most effective in managing high-risk, high volume populations with chronic diseases. Many of the cost of illness models previously used by decision-makers are limited in their approach to design and/or use. In addition, no model specific to Type 2 diabetes exists to support informed decisions for management and reimbursement. This study describes foundational processes related to a secondary database for staging and costing out care of a large cohort population of Type 2 diabetics.