Diabetes mellitus is emerging as a major health problem in sub-Saharan Africa. The economic burden of diabetes mellitus on the patient, family, community, and nation is enormous. The gross national product varied from US$483 in Tanzania to US$3040 in South Africa, with the percentage of gross domestic product spent on health care ranging from 0.7% in Nigeria to 7.15% in South Africa. The per capita expenditure is relatively low in international terms. It follows from these figures that the region has limited resources to invest in diabetes care. The limited availability of private medical insurance and the absence of a free national health service in most countries of the region mean that the burden of diabetes care is on the patient or the family. There is limited information on the economics of diabetes care in sub-Saharan Africa. In Tanzania, about US$4 million would have been required to take care of all patients with diabetes in the year 1989–1990, which translates to US$138 per patient per annum. This sum is equivalent to 8.1% of the total budgeted health expenditure for that financial year and well above the allocated per capita health expenditure in Tanzania of US$2 for the year 1989–1990. In Cameroon, the average direct medical cost of treating a patient with diabetes in 2001 was US$489, with 56% of this cost spent on hospital admissions, 33.5% on antidiabetic drugs, 5.5% on laboratory tests, and 4.5% on consultation fees. The direct medical costs for treating all diabetic patients in Cameroon represented about 3.5% of the national budget for the 2001–2002 financial year. A rough estimate (published from Tanzania) of indirect cost of diabetes calculated as healthy life days lost by a diabetic patient because of premature death, disability before death, chronic disability, and acute illness due to diabetes was 4100 days per patient, of which 69% was due to premature mortality. There is a need for well-targeted studies on the economic burden of diabetes from sub-Saharan Africa. In a region with limited resources and where every decision should be seen in terms of cost and outcomes, the use of cost-effectiveness and cost–benefit studies to evaluate the economic efficiency of diabetes treatment, interventions, and programs should be encouraged.