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ABSTRACT Introduction Little research has been done to systematically evaluate concerns of people living with diabetes through social media, which has been a powerful tool for social change and to better understand perceptions around health-related issues. This study aims to identify key diabetes-related concerns in the USA and primary emotions associated with those concerns using information shared on Twitter. Research Design and Methods A total of 11.7 million diabetes-related tweets in English were collected between April 2017 and July 2019. Machine learning methods were used to filter tweets with personal content, to geolocate (to the US) and to identify clusters of tweets with emotional elements. A sentiment analysis was then applied to each cluster. Results We identified 46,407 tweets with emotional elements in the USA from which 30 clusters were identified; five clusters (18% of tweets) were related to insulin pricing with both positive emotions ( joy, love) referring to advocacy for affordable insulin and sadness emotions related to the frustration of insulin prices, five clusters (12% of tweets) to solidarity and support with a majority of joy and love emotions expressed. The most negative topics (10% of tweets) were related to diabetes distress (24% sadness , 27% anger , 21% fear elements), to diabetic and insulin shock (45% anger , 46% fear ) and comorbidities (40% sadness ). Conclusions Using social media data, we have been able to describe key diabetes-related concerns and their associated emotions. More specifically, we were able to highlight the real-world concerns of insulin pricing and its negative impact on mood. Using such data can be a useful addition to current measures that inform public decision making around topics of concern and burden among people with diabetes. Significance of Study What is already known about this subject? It is very challenging to collect representative data at a population level to understand what are the key concerns of people with diabetes in real life. Social media platforms, such as Twitter, may serve as a relevant source of information to supplement traditional population health studies. There are worldwide inequalities in access to insulin. What are the new findings? With 18% of the tweets related to insulin pricing, this is a major concern in the diabetes community in the USA. People regularly express fear, anger and sadness about potential diabetes-related complications and comorbidities. However, there is a lot of support and solidarity among the diabetes online community, with numerous posts related to positive emotions How might these results change the focus of research or clinical practice? Our work presents a reproducible approach to easily capture information about key diabetes-related concerns, that is usually not available in typical clinical or epidemiological studies. This information can supplement data from clinical or epidemiological studies to inform public health strategies to deal with diabetes-related prevention, management and treatment