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Background: The United Arab Emirates (UAE) has one of the fastest growing adult populations with diabetes mellitus (DM). In 2018, approximately 1.4 million people in the UAE had DM, posing a significant societal cost burden. Owing to a lack in published research on the disease, the true extent of its effects may be unknown. Our study seeks to contribute to the DM literature by estimating its 2018 direct costs in the UAE. Methods: We used random sampling to estimate direct costs. A survey of 400 adults with types 1 and 2 DM captured patients' demographic data and history of medical services received. Direct complication costs were analyzed through a second survey involving 38 of the original 400 participants who experienced DM complications. We accompanied this qualitatively with structured interviews alongside medical consultants from Al Qassimi Hospital, Sharjah. Results: Direct types 1 and 2 DM costs amounted to approximately USD 4.16 billion, representing 23.25% of the UAE's total health expenditure and 1% of its gross domestic product in 2018. Total annual average direct costs per person amounted to USD 2968.98, 35.75% of which were related to hospitalization and complications, 23.26% to consultation, 16.11% to oral drugs, 9.94% to insulin drugs, 5.94% to DM devices, and 9.00% to other factors. Additionally, the average direct cost for type 1 DM (USD 7136.70) was almost 2.85 times higher than that of type 2 DM (USD 2505.90). Conclusion: Our findings can help address the economic implications of DM prevention and treatment in the UAE. [ABSTRACT FROM AUTHOR]