Background: Management of type 1 diabetes places a considerable burden upon patients in terms of frequent insulin injections and blood glucose monitoring. Aims: Patients' fears and thoughts concerning diabetes and treatment were explored in two focus groups. The features of insulin therapy most likely to influence treatment preferences of type 1 patients were investigated. These features would then be used to inform a quantitative patient preference study using a discrete choice experiment. Method: This qualitative study utilised two focus groups, guided by a detailed discussion script based upon clinician input and literature review. Six main topics related to diabetes and insulin therapy were discussed; impact on patient's lifestyle, hypoglycaemic events, predictability and ability to maintain blood glucose levels within recommended targets, injection devices, and negative effects of insulin therapies. In addition, the value people would place on improved insulin therapy measured in terms of their willingness to pay for new therapies, was discussed. Participants were recruited using a screener based upon clinician input. A total of 11 participants attended the two sessions. Transcripts were analysed using content analysis. Results: Participants reported that all six areas were of significant importance in diabetes management. Diabetes and insulin therapy had a huge impact on lifestyle in terms of activity and diet. Fear and experience of hypoglycaemic events were reported as significant concerns. Participants described predicting variation in glucose levels as the key to better management. Participants were willing to pay from £0.70 to £5.00 a day for a better insulin therapy. Conclusion: Diabetes and insulin therapy affects many areas of a patient's life. These data may help understand patients' motivations and treatment preferences, and shape future management and improve diabetic care.Eur Diabetes Nursing 2006; 3(1): 92-97.