OBJECTIVES: Management of A1c (A), blood pressure (B) and cholesterol (C) levels is essential to reduce the risk of diabetic complications. In the past two decades, the results of landmark trials have led to increasingly aggressive treatment regimens and thus more intensive use of glucose-lowering, anti-hypertensive and lipid-lowering medications for patients. We examined the trends of the use and cost of the three types of drugs among diabetes patients in the U.S. between 1987 and 2010. METHODS: Using the 1987 National Medical Expenditure Survey (n=22538), and the Medical Expenditure Panel Survey in years 1997-98 (n=57652) and 2009-10 (n=44815), we estimated the utilization and expenditures of ABC-control-related prescription medications among self-reported diabetes patients at the 3 time points. Within each drug type, usage was measured by the number of medication classes patients received, the share of each class and the total number of prescription medication encounters. Cost was measured by the payments from all payers, and presented in 2012 dollars. RESULTS: Between 1987 and 2010, the number of glucose-lowering encounters per patient nearly doubled. Patients used more varied classes. Usage of insulins and sulfonylureas declined from 38.7% and 67% to 29.9% and 35% respectively; Usage of initially unavailable medication classes -- metformin, thiazolidinediones and DPP-4 inhibitors -- increased to 59.2%, 14.5% and 9.5%, respectively, in 2010.  The patients that received ≥2 classes of glucose-lowering medications increased from 6% to 44%.  Similar trends were observed for the other two drug types. The annual medical spending on glucose-lowering, anti-hypertensive and lipid-lowering drugs increased from $131 to $1,009, $62 to $647 and $146 to $449, respectively. CONCLUSIONS: Usage and cost of medications for ABC control among diabetes patients increased substantially in the past two decades. Future studies may consider the impact of these increases on adherence and long-term outcomes.