Type 2 diabetes causes a significant economic burden on the healthcare system in developed countries. Management of macro and micro vascular complications contributes as a major part of the direct costs. OBJECTIVE: Estimate the incidence, prevalence, current management and direct costs of cardiovascular and renal complications in type 2 diabetic patients in the French setting. METHOD: A representative sample of 5,478 diabetic patients was randomly selected from a database collecting on-line medical data in a network of 650 French GPs. Patients were selected on the criteria of at least two visits to their physician on the period May 2000-April 2001. A questionnaire was sent by mail to the GPs to collect additional retrospective medical data on renal and cardio-vascular complications. Corresponding costs were estimated with unit costs from external sources. RESULTS: The mean duration of diabetes was 10.0 years and the mean age was 64 years. 29% of patients had a Hb1c < 6.5% and 39.2% in the range 6.5-8%. Annual incidence of main complications (Myocardial Infarction, Stroke, Congestive Heart Failure, Chronic Renal Insufficiency and End-Stage Renal Disease) were estimated in the range 0.54 to 1 %. 48% of the patients had BP > 140/80 mmHg. The study showed that 26.7% of patients had no Hb1c testing during the last year, 48% no LDL cholesterol, 40% no creatininemia and 60% no ophthalmologic surveillance. The direct annual costs associated with these complications were estimated 1 Billion Euros for the whole French diabetic population (1.5 million). Contribution to this cost was as following: stroke 36%, MI 22.2%, CHF 17.4% and ESRD 24.4%. CONCLUSION: Considering the current glycaemic control and the quality of management of diabetic patients, substantial benefits could be achieved that would reduce the extra-costs of complications.