This study estimated the resource utilization and direct medical costs in Italian diabetes centers (DCs). Hospital admissions for major chronic complications were not considered since DCs deliver primary care and follow up only complications unequivocally related to diabetes-acute complications and diabetic foot. The multicenter, prospective, observational study involving 31 Italian DCs included a total of 1,910 patients classified into eight prognostic groups by type of diabetes (types 1 and 2), metabolic control (HbA1c >7.5%, HbA1c < or =7.5%) and age (< or =60, >60). The average total cost of type 1 diabetes per patient per year ranged from 762 euro in group 2 (age < or =60, HbA1c >7.5%) to 1,060 euro in group 4 (age >60, HbA1c >7.5%), and that the cost of type 2 diabetes from 423 euro in group 5 (age < or =60, HbA1c < or =7.5%) to 613 euro in group 8 (age >60, HbA1c >7.5%). The study brought to light the wide variability in the single cost components across clinically defined groups of patients. The cost of diabetes management in the strict sense was significantly affected by the type of diabetes and metabolic control.