OBJECTIVES: The aim of this study was to assess the burden of peripheral arteriopathy (PA) in diabetic patients. METHODS: Eligible patients were identified through a data warehouse (DENALI), which matches clinical and economic data of about 9.9 million individuals of Lombardy, a northern Italian region which represent 16.4% of the Italian population. The study population was made of all individuals over 40 with a diagnosis of diabetes who during the period 1-1-2002 to 31-12-2009 had an hospital admission (index event) attributable to PA disease. The identified individuals were followed-up from the index event to a maximum of 7 years. We evaluated demographic characteristics of the study population and costs (hospitalizations, drugs and outpatient examinations/visits) from the National Health Service’s perspective. RESULTS: During the observational period 18,344 subjects (5% of the diabetic source population) had at least one hospital admission of interest. Median age (min-max) at the index date was 73(40-102) and 31% of the study population had a Charlson comorbidity index higher than 3. The overall mortality was 11.3 deaths every 100 patient-years (95%C.I., 11.1-11.6). Forty-four percent of the study population had at least one procedure among vascularization, minor and major amputation. Mean cost and corresponding 95% C.I. (€/patient-year) for PA diabetic patients was 14,085(12,344-16,400) in the index year and around 7,000 in the following periods of observation. Hospitalizations represented the driver of total costs. CONCLUSIONS: This study attempted to describe the epidemiologic and economic burden of diabetes patients with PA complications, showing the relevance of related epidemiologic and economic aspects.