What people know and how people feel about type 2 diabetes will affect demand for early identification of the disease at an asymptomatic stage. This paper reports on the selected findings from a broader study of the attitudes and perceptions of GPs, nurses and patients about screening for type 2 diabetes. Purposive sampling was used to identify several practices across north-east England, and data were collected via semi-structured interviews with GPs, nurses and patients from these practices. Interview transcripts were analysed by drawing on the principles of grounded theory, with the aid of NUD*IST software. This paper focuses upon the perceived seriousness of this condition, and the implications such perceptions may have in practice. Results indicate a marked variation in perceptions of seriousness between health practitioners and patients. This diversity can be explored via three overlapping frameworks identified during the study: medical, political and personal. A medical framework suggests that individuals' perceptions are guided by a medical model. This links the seriousness of type 2 diabetes with concepts of prevention and cure, a need for individual lifestyle change, bias towards younger patients and anticipated use of medication. In short, diabetes is perceived to be more serious as it becomes more medicalized. A political framework views seriousness in terms of national incentives and priorities, a recognized need for a centralized push for early detection and financial inducements. Diabetes detection is not generally thought to be attractive politically compared with systematic cancer screening. A personal framework suggests that perceptions of seriousness are determined by individual attitudes, knowledge and experiences of diabetes. The findings offer important insights into how perceptions of the seriousness of type 2 diabetes may influence detection and management of this disease in primary care.