OBJECTIVES: Diabetes is associated with a substantial and growing clinical and economic burden in India, accounting for approximately 11% of national healthcare expenditure in 2010.  Moreover, the management of diabetes-related complications is the main contributor to the overall cost of the disease.  The objective of the study was to obtain current direct costs for the management of diabetes-related complications in India. METHODS: Direct costs of diabetes-related complications were derived from interviews with three expert diabetologists based in India, with the exception of the costs of renal procedures, which were derived from published, country-specific literature.  Mean values based on all experts’ estimates were calculated for first and subsequent years for each complication.  Costs were classified into 6 groups (management, cardiovascular complications, renal-complications, acute-events, eye-disease and neuropathy/foot ulcers).  Costs are presented in 2011 Indian Rupees (INR) with equivalent US dollar (USD) values (exchange rate USD1 to INR50.23). RESULTS: At an individual patient level the most expensive diabetes-related complication was end-stage renal disease, where both peritoneal dialysis and hemodialysis were associated with direct annual costs of INR788,059 and INR755,223, respectively, and renal transplant was associated with costs of INR577,910 (USD11,505) in the year of transplant and INR295,522 (USD5,883) in each subsequent year.  The direct cost of cardiovascular complications was also high; for example myocardial infarction cost approximately INR162,500 (USD3,235) in the year of event and INR16,500 (USD328) in subsequent years.  Gangrene (INR55,000 [USD1,095] per event) and infect ulcer (INR27,500 [USD547] per event) had the highest costs of the diabetic foot complications.  CONCLUSIONS: In India, direct costs associated with the management of diabetes-related complications, in particular renal and cardiovascular complications, contribute significantly to the economic burden associated with diabetes.  Costs presented in this study will provide useful data for economic evaluations of diabetes interventions in India.