The European Coalition for Diabetes (IDF Europe, FEND, PCDE and EURADIA) has once again joined forces to publish this 4 edition of the Policy Puzzle at a time when Europe is still faced with the growing epidemic of diabetes, despite considerable and increasing political awareness of the health risks of diabetes and the realisation that the disease is largely preventable. By presenting a review of the situation in Europe and how diabetes has evolved over the last three years, this 4th edition aims to monitor the evolution of the current epidemic and report on the national policies and practices that exist across 47 European countries. As well as providing evidence to policy makers and key stakeholders in diabetes about the epidemic and related policy frameworks, this comprehensive audit will provide evidence to improve the implementation of policies.