OBJECTIVES: This qualitative study was conducted to address critical gaps on how type-2 diabetes patients using basal insulin understand the concept of their diabetes “being in control”. METHODS: Forty-nine type-2 diabetes patients on basal insulin (focus groups N=45, individually N=4) and 9 health care providers (HCPs), were interviewed in Sweden, Denmark, UK, and Switzerland. Patients were asked about their understanding of control, obstacles to achieving  and how their understanding of control compared with their HCP. The interviews were transcribed, coded and qualitatively analyzed, based on grounded theory, to identify and quantify emerging themes. RESULTS: The mean age of patients was 64 (range 28-83) with approximately 50% considering their diabetes out of control. In contrast to the accepted medical definition of control  based on HbA1c (average plasma glucose value), 58% of patients associated diabetes control with factors other than HbA1c; 80% associated control with daily or hourly meter readings; 76%  day-to-day feelings; 40% sugar fluctuations, and 38% with limitations in daily life. Major obstacles to control were: managing diet/appetite: 87%; inadequate education from HCPs: 71%; lack of social support and schedule and lifestyle issues: 69%. Only 42% of patients mentioned medication regimen as affecting control. Twenty-seven percent felt they had different definitions of control than their HCPs, and 24% wanted HCPs to talk about factors besides HbA1c. Further, while 44% of HCPs interviewed said the easiest way to achieve control was intensifying medication, patient’s often associated intensification and/or complex medication regimens as a negative aspect of control. CONCLUSIONS: The concept of “being in control” has multiple meanings to patients and these definitions are often at odds with HCP definitions. This discordance may result in suboptimal patient-HCP interactions as well as contribute to physician inertia to initiate and/or intensify treatments. Patient education and research is needed to better understand the management of uncontrolled diabetes.