Objective: To estimate the health utility impact of diabetes-related complications in a large, longitudinal U.S. sample of people with type 2 diabetes. Research Design and Methods: We combined Health Utility Index-3 data on patients with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Action for Health in Diabetes (Look AHEAD) trials and their follow-on studies. Complications were classified as events if they occurred in the year preceding the utility measurement; otherwise, they were classified as a history of the complication. We estimated utility decrements associated with complications using a fixed-effects regression model. Results: Our sample included 15,252 persons with an average follow-up of 8.2 years and a total of 128,873 person-visit observations. The largest, statistically significant (p < 0.05) health utility decrements were for stroke (event: −0.109; history: −0.051), amputation (event: −0.092; history: −0.150), congestive heart failure (CHF; event: −0.051; history: −0.041), dialysis (event: −0.039), estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 (event: −0.043; history: −0.025), angina (history: −0.028), and myocardial infarction (MI) (event: −0.028). There were smaller effects for laser photocoagulation, and eGFR < 60 mL/min/1.73 m2. Decrements for dialysis history, angina event, MI history, revascularization event, revascularization history, laser photocoagulation event, and hypoglycemia were not significant (p >= 0.05) Conclusions: Using a large study sample and a longitudinal design, our estimated health utility scores are expected to be largely unbiased. Estimates can be used to describe the health utility impact of diabetes complications, improve cost-effectiveness models, and inform diabetes policies.