OBJECTIVES: To assess, in a community setting, the clinical and economic outcomes of individuals with diabetes at very high cardiovascular (CV) risk (patients with type 2 or type 1 diabetes, with target organ damage, such as microalbuminuria - ESC/EAS Guidelines 2011). METHODS: Data for over 2.9 million subjects were extracted from 6 Local Health Units (ARNO Observatory, an administrative database containing data on hospitalizations, prescriptions and diagnostic/outpatient visits). The index period lasted from January 1 to December 31, 2011. RESULTS: Of the 2,989,512 subjects identified, 101,217 patients (3.4%) had diabetes with very high CV risk. 82.9% were aged over 60 years. At 1-year follow-up, 46.1% were prescribed statin therapy, of which 56.9% being prescribed high intensity statins (Atorvastatin 40, 80 mg/dL, Rosuvastatin 20, 40 mg/dL). Adherence to treatment (20% tolerability in one year follow-up treatment - CORE Study 2013) was higher among high intensity statin users compared to low intensity statin users (53.6% vs 40.1%). Over the 1-year follow-up period, 23,116 patients (22.8%) were hospitalized for any CV events. The average yearly cost per patient, on the high risk diabetic patients, supported by NHS was 3,001 €/year (hospitalizations: 1,555€; drugs: 998€; diagnostic and outpatient visits: 449€). CONCLUSIONS: In this community hospital setting, diabetic patients at very high risk of CV were frequently hospitalized for CV events. Although at high risk,  less than 50% of patients was prescribed on statin therapy and adherence was suboptimal. Individuals with diabetes at very high CV risk utilize a significant portion of economic resources, hospitalization being the main cost driver. Local Health Authorities together with Physicians and Patient Associations are working to close the gap between the existing evidence-based recommendations and current clinical practice which could result in a reduction of both diabetes morbidity and health cost.