Over the last decade the situation for people with diabetes mellitus in Europe has changed significantly. The number of patients increases continuously, the age of diagnosis decreases and effective management grows to become a burden for European healthcare systems. In this situation numerous stakeholders try to develop concepts for innovative chronic care management as well as individualized and personalized diabetes management. A major focus is set to activities for early screening and prevention of the diabetes and associated diseases. The present article will give an overview about current achievements in European projects addressing the unmet needs in diabetes management and also to introduce undergoing projects in the field of diabetes prevention and care. Furthermore, the SweetSmart concept will be presented, which is the initiation of a strategy to individualize interventions for the prevention of diabetes and care management. In the current discussion about the management of health care resources it is important to have a strategic vision about a realistic future of innovative chronic care management.