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Managing type 2 diabetes in primary care poses many challenges for health professionals in preventing and managing complications. These challenges are greatly amplified in those environments with high levels of deprivation and ethnic diversity.A retrospective structured audit of patient electronic medical records, with systematic extraction of clinical data, was undertaken in three general practices in an ethnically diverse outer London primary care trust. The records of 646 patients were analysed.Patients from minority ethnic groups were significantly more likely to have poor glycaemic control (p<0.05), and a higher proportion of patients with poor control were aged under 60 (p<0.05). Asian patients showed much higher levels of overall body mass index (BMI) risk, with all Asian patients (100%, n=85) having a sub-optimal BMI compared to other patient groups (p<0.001). Younger age (50 years and under) was associated with less frequent contact (p<0.05). Patients managed solely in general practice had significantly better glycaemic control than those in shared care schemes (p<0.01). Feedback from practices found that diabetes support services were limited and, as such, influenced health professionals' ability to provide some on-going care in terms of dietary advice and insulin initiation.The audit findings suggest that there are some significant relationships between diabetes outcomes, patient characteristics and the care process. It may be possible to develop interventions suitable for metropolitan primary care and which reflect the diversity of population needs. Copyright © 2008 John Wiley & Sons.