The main objective of Work Package (WP) 9 is to evaluate the 2007 ESC-EASD Guidelines on CVD prevention in diabetic patients.

In terms of dissemination, almost 9 doctors out of 10 have a copy of the guidelines at their disposal in their practice in Europe, and 8 out of 10 use it.

We conducted an e-survey to evaluate both the impact of guidelines in prevention of cardiovascular disease in diabetic patients, and the attitudes and uses of the ESC-EASD Guidelines by physicians in Europe.

We observed unacceptably high rates of important clinical data missing in the health records (26% for BMI, and 17% for LDL).

There is a worryingly high variability in the strategies, criteria and tools used for detecting diabetes among European physicians. There is also a high variability in the assessment of cardiovascular risk among European primary physicians, with many different approaches and risk scores used. There are also large discrepancies in managing patients with impaired glucose tolerance to try and delay the onset of diabetes.

A very high proportion of patients were not reaching the optimal recommended target levels for BP (74%) and LDL (83%). There are also remarkable discrepancies regarding which BP and LDL target values should be used, also regarding the use of aspirin in diabetics.

Numerous barriers prevent doctors from using the guidelines: there are too many guidelines; they require too much homework to keep up to date; and their content is not necessarily adapted to daily clinical practice. Scientific societies must, therefore, identify more effective strategies to implement professional guidelines and overcome these barriers.

These findings are being widely disseminated. And the key lessons are already being acted upon. Finally, during 2013, Professors Lars Ryden and Jaakko Tuomilehto, both WP9 co-investigators, have participated very actively in updating the 2007 ESC-EASD Guidelines and developing the new version of the ESC-EASD Guidelines 2013. They worked respectively as co-chair and as member of the Guidelines Task Force Expert Panel and took into account the findings of this work package to improve implementation.

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