OBJECTIVES: Data from the 2006 Malaysian National Health Morbidity Survey showed that the overall prevalence of diabetes in Malaysia is over 11%.  The high prevalence of diabetes and the management of diabetes-related complications has considerable implications in terms of health care spending, with 16% of overall health care spending in Malaysia attributed to the management of diabetes in 2010.  The objective of the study was to estimate current direct costs associated with diabetes-related complications in Malaysia.  METHODS: Most direct costs of diabetes complications were derived from interviews with three key opinion leaders in the field of diabetes in Malaysia.  Dialysis costs were sourced from published literature.  Mean costs were then estimated calculated for first and subsequent years for each event/complication.  All costs are presented in 2011 Malaysian Ringgits (MYR) (converted to US dollars [USD], exchange rate USD 1 to MYR 3.14). RESULTS: End-stage renal disease was associated with the highest annual per patient costs, with mean first year costs for hemodialysis and peritoneal dialysis being MYR23,500 (USD7,070) and MYR36,000 (USD11,465) per year, respectively.  Costs of renal transplant were MYR26,000 (USD8,280) in the year of transplant and MYR3,000 (USD955) per year in subsequent years.  Other complications associated with high direct costs were amputation and prosthesis (MYR425 and MYR3,750, respectively [USD135 and USD1,194, respectively]), cataract operation (MYR3,221, USD1,026) and myocardial infarction (MYR1,233 [USD393] in year of event and MYR367 [USD117] per year in subsequent years).  Additionally, neuropathy was associated with mean costs of MYR900 (USD287) in the first year and MYR675 (USD215) per year thereafter. CONCLUSIONS: Diabetes is associated with a substantial economic burden in Malaysia, and the management of diabetes related complications is likely to represent a significant proportion of the overall costs.  The cost data reported in this study represents a useful resource for future economic evaluations of diabetes in Malaysia.