OBJECTIVES: The study objective was to provide current patient-level paid cost estimates for complications among adult patients with Type 2 diabetes. METHODS: Patients ages ≥18 with ≥1 claim for a diabetes-related complication were selected from the PharMetrics Health Plan Claims Database, a large U.S. claims database including medical and pharmacy claims for >75 million patients from 80 health plans, during 2009-2010. Patients were continuously-enrolled in the same health plan ≥12 months before and ≥24 months after the first complication claim and had a diagnosis of Type-2 DM prior to their first complication.  Patients with gestational diabetes, missing cost, or Medicare Reimbursement or SCHIP coverage were excluded. Diabetes-related complications included cardiovascular events, gangrene, amputation, foot ulcer, renal disease, chronic kidney disease, eye disease and neuropathy.  All direct costs in the 2-years following complications were inflated to 2011 dollars. RESULTS: There were 113,222 adult Type-2 DM patients identified with a mean age of 58 years and 53% male. The most frequent complications included neuropathy (27%), non-proliferative retinopathy (22%), renal disease (21%) and heart failure (14%). The most frequent treatments were oral antidiabetics (69%), antihyperlipidemics (62%), ACE-inhibitors (44%), insulins (34%) and antidepressants (29%). The mean (SD) total cost per patient was $38,849 ($71,253) [inpatient $14,086 ($45,290), outpatient $17,319 ($40,887), and pharmacy $7,443 ($12,152)]. Renal disease cost among those with renal disease averaged $20,908 ($80,294), foot ulcers costs among those with amputation/foot ulcers averaged $6,358 ($18,017) and heart failure costs among those with cardiovascular/cerebrovascular disease averaged $5,764 ($24,384). CONCLUSIONS: Patients with Type 2 DM exhibited substantial healthcare costs associated with medical complications. The most costly conditions are renal disease, foot ulcers/amputations and cardiovascular/cerebrovascular diseases.