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Background  Clinical guidelines for type 2 diabetes are a resource for providers to manage their patients and may help highlight specific areas in need of further education and training. We sought to determine how often guidelines are used and the relationship to physicians’ diabetes-related knowledge and decision making.    Methods  Existing users of electronic clinical support tools were invited to complete an online questionnaire. A knowledge score was calculated for five questions related to prevention of diabetes and treatment of its complications. We explored the association of clinical guideline use with diabetes-related knowledge and self-reported decision making using logistic regression models, adjusted for key covariates.    Results  Of 383 physicians completing the questionnaire, 53% reported using diabetes guidelines routinely. Mean diabetes knowledge score for guideline users (GU) was significantly higher than non-guideline users (NGU) (3.37 ± 0.072 vs. 2.76 ± 0.084; p < 0.001). GU were significantly more likely to report a good understanding of type 2 diabetes medications (OR = 2.99, 95% CI 1.95-4.61; p < 0.001). GU were less likely to report their unfamiliarity with insulin as an important barrier to early insulin use (OR = 0.41, 0.21-0.80; p = 0.007) and with pharmacologic options as a barrier to prescribing intensive multifactorial interventions (OR = 0.32, 0.17-0.58; p < 0.001). Associations remained significant after adjusting for physician specialty, practice volume and frequency diagnosing or treating diabetes patients.    Conclusions  Significant gaps exist in diabetes-related knowledge and decision making among practicing physicians, as highlighted by clinical guideline use. The development of educational and training strategies to address these needs may ultimately improve outcomes for patients with diabetes and should be investigated in the future.    Electronic supplementary material  The online version of this article (doi:10.1186/1472-6920-14-186) contains supplementary material, which is available to authorized users.

The use of clinical guidelines highlights ongoing educational gaps in physicians’ knowledge and decision making related to diabetes