OBJECTIVES: There is increasing focus on the ethical analysis in Health Technology Assessments (HTA). Due to the escalating epidemic of diabetes, diabetes has become an urgent health concern. We therefore systematically reviewed published articles describing the ethical aspects of pharmacological treatment and self management of diabetes. METHODS: PubMed was searched from inception to 2009 using the following combinations of keywords: ethics AND diabetes NOT screening NOT transplant. Articles were initially screened for relevance by reading title and abstract. If deemed appropriate, by two independent reviewers, full copies of the remaining articles were retrieved for further review. RESULTS: Out of 336 articles, only six studies were deemed appropriate. The main reason for this high level of rejected articles was that the majority of identified articles commented on the ethical approval in connection to conducting clinical studies rather than on the ethical aspects of implementing and using the specific technology. One study described the ethical concern related to the costly late complications of diabetes compared to preventing late complications by prescribing and reimbursing insulin. Other ethical issues concerned self management and the transferral of responsibility from physician to patient and the patient’s capabilities for self management. For people with impaired glucose tolerance there were also ethical issues related to initiating a preventive pharmacological treatment of the “otherwise well”. Lastly, there is an ethical issue between the normative gold standard for a healthy and moral lifestyle and a culture of self that values authenticity and originality. CONCLUSIONS: Due to the escalating prevalence of diabetes and emphasis on ethical analysis in HTAs, both payers and the industry needs to get a better understanding of the ethical aspects of self management and pharmacological treatment of diabetes. More research should be allocated towards investigating the ethical aspects of self management and pharmacological treatment of diabetes.