OBJECTIVE: The microvascular and macrovascular complications of diabetes are generally associated with poorer health related quality of life, but few studies have assessed utility values associated with specific individual or multiple complications. This study estimated utilities for the most common complications, to establish whether patients have a poorer quality of life than those without complications. METHODS: EQ-5D index data were generated through cross-sectional postal surveys of patients on two regional registers in the UK, stratified according to the 17 most prevalent individual or multiple complications (including "none"). Amputation and blindness did not appear in this list. Subgroup analysis was undertaken on patients without chronic co-morbidities. RESULTS: Response rates were 62% in Brighton (n = 589) and 65% in Salford (n = 491). Nine of the most prevalent complication groups in Brighton and seven in Salford represented multiple complications. In Brighton, the lowest mean score was for patients with previous ischaemic heart disease plus peripheral vascular disease or claudication. Symptomatic neuropathy appeared in five out of the eight complication groups, which had significantly lower mean scores (p <0.05) than the group without complications. Normalising for co-morbidities did not fundamentally change the findings, although mean scores were generally higher in the subgroups without co-morbidities. Stroke appeared in two, and angina in three, of the seven complication groups, which had significantly, lower mean scores (p <0.05) than the group without complications. CONCLUSIONS: Patients with the most common diabetic complications have a poorer quality of life than those without complications. Understanding the interaction of different complications on patients' quality of life will be increasingly important as new strategies are explored to reduce the risk of such complications.