Diabetes is a serious disease, which is often accompanied by complications, such as blindness, kidney failure, heart attacks, strokes and amputations. High blood pressure and abnormal cholesterol levels are frequent comorbidities. Diabetes has an immense impact on public health and medical care. In South Carolina (SC), medical costs rise with increased duration of the disease, and lifespan is shortened by 5 to 10 years in most patients. To describe the burden of diabetes in SC, we examined the public health surveillance systems available to estimate the prevalence, mortality and hospitalization rates and some disability statistics and hospital charges. Diabetes is the 7 leading cause of death in SC, directly or indirectly claiming more than 3,000 lives annually, and the 5 leading cause of death in blacks, claiming about 1,200 black lives each year. Minorities, predominantly blacks, experienced a substantially higher death rate and more years of potential life lost than whites. The racial disparity in mortality has widened over the past 10 years. People with diabetes are at increased risk for blindness, lower extremity amputation, kidney failure, nerve disease, hypertension, ischemic heart disease and stroke. Approximately 450,000 South Carolinians are affected by diabetes, many of whom were still undiagnosed in 2010. One of every 5 patients in a SC hospital has diabetes, and 1 in every 10 visits to a SC emergency room is diabetes related. The total charges for diabetes and diabetes-related hospitalizations and emergency room visits were more than $4.2 billion in 2010.