OBJECTIVES: Diabetes Mellitus affects approximately 60 million Europeans, with prevalence increasing .  Diabetes is associated with a number of severe comorbidities, including visual impairment, lower extremity conditions/amputation, neuropathy, renal disease and cardiovascular disease.  Managing underlying disease can significantly improve disease outcomes, though adherence remains a challenge.  With the major expansion of consumer technology-based healthcare solutions and European initiatives like the REACTION project, diabetic patients are more involved in care than ever before.  Our study looks at patient centric drivers of adherence to technology based diabetes self-management in Europe.   METHODS:   An in-depth analysis of current European initiatives implementing digital health management solutions was performed, as well as overall demographic and statistical research of the European diabetes population.  Additionally, using dual data collection methods, involving telephone-based interviews and internet-based questionnaires, a total of 2,307 diabetes patients in the US were sampled.  Questions focused on demographic, lifestyle, treatment, access to information, and socioeconomic status.  Data from US diabetic patient preferences related to digital health solutions and patient engagement strategies were reviewed in the context of diabetes self-management solutions being deployed in Europe. RESULTS: Socioeconomic disadvantage amongst European citizens has been shown to significantly contribute to development of diabetes and related complications.  Among our study population, diabetics with a lower socioeconomic status and the elderly showed drastically lower rates of access to internet at home or at work (58.1% and 66.3%, respectively), as compared to those who were employed with an average income >$60,000 (92.2%).  This same group preferred to get information from their health care providers versus the internet. CONCLUSIONS: While programs are being developed to impact diabetic treatment adherence via IT based diabetes self-management solutions, patient characteristics and preferences need to be understood to optimize impact.  Additional research is required to understand the best methods to reach these at-risk populations.