The health care system has been very successful in meeting the first set of challenges in diabetes care. As a consequence of this success a new set of challenge, low levels of self-care, poor control and unresolved emotional problems, has emerged to challenge the health care professional. Patient empowerment has been cited as an approach to address these issues. However much of this literature does little to define empowerment, and tends to rely on philosophical rather than empirical argument. This paper defines empowerment as involving at least 5 key features; acceptance, affect, autonomy, alliance and active participation. These concepts are defined, and the pertinent diabetes literature is reviewed. Empirical studies demonstrate a clear association between aspects of empowerment and self-care behaviour. Although intervention studies have tested some aspects of the empowerment model, there is as yet no published empirical study that has tested the empowerment model in its entirety. Until such data emerges the empowerment model, although promising, can only be argued for on philosophical grounds. Copyright (C) 2000 John Wiley and Sons, Ltd.