Diabetes mellitus (DM) is a chronic disease that requires continuous medical care and patient self-management, education and support in order to prevent acute complications and reduce the risk of long-term complications. It is considered one of the greatest health challenges of the twenty-first century. In 2013 DM caused 5.1 million deaths [
1] and a person dies from diabetes every 6 s [
1]. According to the International Diabetes Federation (IDF), 8.3% of adults have diabetes, and the number of people living with diabetes is expected to rise from 382 million in 2013 to 592 million in less than 25 years [
1]. Type 2 DM accounts for 90% of all diabetes cases [
2]. The 2006 World Health Organization (WHO) diagnostic criteria for diabetes are fasting plasma glucose ≥7.0 mmol/l (126 mg/dl) or 2‑h plasma glucose ≥11.1 mmol/l (200 mg/dl) [
3]. In 2009, an international expert committee including representatives of the American Diabetes Association (ADA), the IDF and the European Association for the Study of Diabetes (EASD) recommended the use of the HbA1c test to diagnose diabetes, with a threshold of ≥6.5% (48 mmol/mol) and the ADA adopted this criterion in 2010. Furthermore, the two most influential large-scale clinical trials of diabetes therapeutic regimens, the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS), have shown that improving HbA1c levels slows the development and progression of eye, kidney, and nerve complications in both type 1 and type 2 DM [
4‐
6]. There are two primary techniques available to assess the effectiveness of the glycemic control management plan: blood glucose and HbA1c monitoring [
7]. The most abundant minor hemoglobin component is HbA1c and it is formed by the chemical condensation of hemoglobin and glucose [
6,
8]. Glycated hemoglobin is measured primarily to identify average plasma glucose concentrations over prolonged periods of time and HbA1c has a strong predictive value for diabetes complications [
9‐
12]. The target HbA1c level is <6.5% (48 mmol/mol) and this concentration is recommended as a diagnostic indicator of disease control and the effectiveness of therapy. The test should be repeated every 3 months until the target value is reached, and every 6 months thereafter [
13‐
17]. If dietary treatment for DM is not effective, then pharmacological treatment is usually initiated. Unless contraindicated, metformin is recommended as a first line therapy in addition to diet and exercise.
National guidelines for treating DM in the Balkans generally follow European guidelines; however, the rate of routine HbA1c measurements in type 2 DM patient care among practitioners in the Balkans is uncertain. The current study was undertaken to estimate the rate of HbA1c measurement and the level of disease control in patients with type 2 DM in the Balkans, and to evaluate if providing a cost free and simple way to measure HbA1c levels leads to the more aggressive treatment of patients who have poor disease control. The primary objective of this study was to determine the rate of HbA1c testing in patients with type 2 DM among general practitioners (GPs) and diabetes specialists, and to estimate adherence to treatment guidelines. The secondary objective was to establish whether HbA1c testing improves adherence to treatment guidelines.