The increasing prevalence of diabetes and prediabetes makes the cost of diabetes care a pressing concern. Nurses in all settings play a critical role in helping to reduce the cost of diabetes not only for individual patients but ultimately for the health care system. This article focuses on four main issues related to the economic impact of diabetes for patients and health systems: (1) overall estimates of the direct and indirect costs of diabetes and its associated complications, (2) the impact of cost on diabetes care and health outcomes, (3) the ways in which federal- and state-mandated insurance for persons with diabetes is being used to promote more cost-effective and high-quality diabetes care, and (4) the use of cost-effectiveness analysis to evaluate interventions designed to prevent diabetes or diabetes-related complications.