OBJECTIVES The purpose of this analysis is to quantify the additive burden associated with experiencing depression symptoms in patients with type-2 diabetes mellitus (T2DM). METHODS Data were from the 2008 US National Health and Wellness Survey (NHWS), an annual cross-sectional survey of self-reported health care attitudes, behaviors, disease states, and outcomes of adults aged 18+. Analyses were limited to respondents self-reporting a diagnosis of T2DM. Depression symptoms were defined as an affirmative response in the past month to: bothered by feeling down, depressed or hopeless; or bothered by having little interest or pleasure in doing things. Outcomes included health care utilization in the past six months, work productivity as measured by the Work Productivity and Activity Impairment (WPAI) questionnaire, and SF-12v2 summary scores. Logistic and linear regression models were developed to assess independent effects of depression on outcomes, while adjusting for demographics and co-morbidity. RESULTS Among patients with T2DM, 38% self-reported depression symptoms. Adjusting for demographics and co-morbidity, patients with depression symptoms were 1.7 (p<0.001) times as likely to visit the emergency room, 1.6 (p<0.001) times as likely to be hospitalized, and had 2.2 (p<0.001) additional provider visits compared to T2DM patients without depression symptoms. Depression symptoms were also associated with 21.4% (p<0.001) greater impairment in daily activities and a decrease in SF-12v2 physical and mental summary scores of 4.0 (p<0.001) and 12.7 (p<0.001) points, respectively. Among patients who were employed full-time, depression symptoms were associated with 4.3% (p<0.001) greater missed work time, 15.2% (p<0.001) greater lost productivity while working, and 13.4% (p<0.001) greater overall work impairment. CONCLUSIONS In patients with T2DM, depression symptoms were associated with significant burden on health care utilization, work productivity, and health-related quality of life. Proper treatment of both T2DM and co-morbid depression in this population may reduce humanistic and economic burden of disease.