OBJECTIVES: Diabetes Mellitus is best managed through a combination of HbA1c testing, self-testing of blood glucose, and close interactions with HCPs.  It has been previously shown that Italian diabetes patients have a very low rate of adherence to appropriate care, compared to those in other EU countries.  In this study, we examined Italian diabetes patient preferences related to education and monitoring compared to patients in other EU5 countries. METHODS: A total of 3,013 diabetes patients in the EU5 were sampled.  Questions focused on demographic, lifestyle, treatment, access to information, and socioeconomic status.  Data were compared across countries and reported behaviors compared to current patient treatment guidelines. RESULTS: Despite guidelines stating that all patients must receive HbA1c testing twice per year, 42.5% of Italian patients reported receiving an HbA1c test in the past 12 months compared to 70.5% in other EU5 countries.  Instead, these patients are favoring blood glucose self-monitoring, which has been previously shown to be an insufficient substitute for HbA1c testing.  Italian patients also claimed that they do not want their doctor or nurse managing their diabetes more so than patients in any other tested country.  Italians get diabetes information from Newspapers/Magazines, Internet, TV/Radio, Relatives/Friends more than other Europeans (37% v 34%; 33% v 28%; 30% v 26%; 25% v 21% respectively).   CONCLUSIONS: While many Italian diabetes patients are reporting low adherence to guideline driven testing and preferences for managing their own diabetes without intervention from their HCP, change is needed.  This represents a major opportunity for more targeted Italian patient management solutions built on Italian patient preferences and recognition of necessary change drivers to realize more cost-effective care.  This study demonstrates how local patient preferences can impact outcomes, and therefore must be built into chronic disease management solutions for meaningful change to occur.