In order to determine the level of clinically relevant knowledge and practical experience in the ®eld of diabetes at the time of graduation from medical school we conducted a survey amongst 310 ®nal year medical students (135 women, 175 men; age 27.6t2.8 years; number of semesters completed 12.4t1.7) at 21 university hospitals and academic teaching hospitals in Germany. The standardized questionnaire used for the study contained nine questions on the students' general characteristics and education and a further 28 questions concerning manual experience and theoretical knowledge about diabetes. The questions were based on the level of knowledge reached by diabetic patients participating in one of the structured training programs for type I and type II diabetes established in Germany. 81% of the students expressed dissatisfaction with the diabetes teaching they had so far received. Shortly before graduating from medical school 14% of the students had never performed a rapid blood glucose test using a test strip, 45% had never injected insulin and 68% had had no experience with the insulin pen. Individual questions revealed marked gaps in clinically relevant knowledge, particularly as regards diet and practical aspects of diabetes therapy. Students with manual experience achieved better results in the areas acute diabetic complications and practical diabetes therapy compared with students without manual experience ( p<0.05). The results of the survey underline the need to improve the undergraduate teaching of diabetes by adopting a more patient-based and clinically oriented approach. Copyright