In March 2008 the latest American Diabetes Association (ADA) commissioned economic study of the costs of diabetes in 2007 was published. The economic burden of diabetes was quantified in terms of its increased healthcare resource use (direct costs) and lost productivity (indirect costs) and provided a detailed breakdown of the costs attributed to diabetes. In the five years since the ADA published a similar analysis, the number of Americans with diagnosed diabetes has risen from 12.1 to 17.1 million and the economic cost has risen from $132 billion (equivalent to $153 billion in 2007 dollars) to $174 billion. This major analysis is reviewed and the implications for Europe are considered. The findings are similar to those described in earlier US studies and also landmark European economic studies in diabetes. The results are also discussed in the context of the well accepted association of type 2 diabetes and overweight and obesity and because obesity has reached epidemic proportions in developed and developing countries