Objectives: We sought to determine levels of adherence, in eight European countries, to recommendations for the management of type 2 diabetes; also to investigate factors associated with key intermediate outcomes. Research Design and Methods: GUIDANCE was a cross-sectional study including retrospective data extraction from the medical records of people with type 2 diabetes recruited, using a shared protocol, from primary and secondary care sites in eight European countries: Belgium, France, Germany, Italy, Ireland, Sweden, The Netherlands and the UK. The dataset for analysis included 7597 cases. Proportions meeting process and outcome criteria were determined, including between-country variations. Logistic regression was used to investigate potential predictors of meeting targets for HbA1c, blood pressure and total cholesterol.Results: In the total sample, adherence to process recommendations was high for some measures, for example, HbA1c recorded in past 12 months in 97.6% of cases. Target achievement for intermediate outcome measures was lower, with only 53.6% having HbA1c within target. Considerable between-country variation was identified for both processes and outcomes. The following characteristics were associated with an increased likelihood of meeting targets for all three of the measures considered (HbA1c, blood pressure, total cholesterol): male gender, shorter diagnosis of diabetes, having one or more cardiovascular complication, and being prescribed lipid-lowering medication. Conclusions: Compared to earlier reporting, we have identified some encouraging positive trends in Europe in relation to meeting targets for the management of people with type 2 diabetes, but there is still scope for further improvement and greater between-country consistency.