As early as 1989, the St Vincent Declaration warned Europeans of the dangers of ignoring the burgeoning diabetes epidemic. The Declaration called on governments, diabetes organizations and professional societies from countries throughout Europe to unite in efforts to tackle the growing challenge to healthcare in the region. There were high hopes among the European diabetes community that significant action would be taken. But despite the broad stakeholder support for the Declaration’s objectives, significant progress failed to materialize. The former Irish Health Minister echoed these warnings when he spoke in 2004 of the need to recognize diabetes ‘as a priority for action at European level’. Since then, some important ground has been covered at EU level. Michael Hall and Anne-Marie Felton report.