The 2004 National Nursing Home Survey collected cross-sectional data for 11,939 nursing home residents aged >or=65 years representing approximately 1.32 million individuals. That year, 24.6% of nursing home residents had diabetes as a primary admission and/or current diagnosis. Diabetes was present in 22.5 and 35.6% of white and nonwhite residents, respectively. Diabetic residents were admitted more often from acute care hospitals (42.5 vs. 35.3%), were more likely to have a length of stay <or=100 days (22.6 vs. 20.1%), and took more medications (10.3 vs. 8.4). Diabetic residents had 39% higher odds of having emergency department visits in the previous 90 days and 56% higher odds of having a pressure ulcer at the time of the survey. In the U.S. in 2004, one in four nursing home residents aged >or=65 years had diabetes, and diabetic residents had increased odds of several unfavorable outcomes that are important for care planning.