A virtually complete follow-up of diabetic patients treated at the Joslin Clinic since 1930 shows a downward trend in the mortality and corresponding improvement in the survivorship record. The mortality rates of diabetics, however, remain higher than those in the general population; the excess is relatively greatest at ages twenty-five to thirty-four and least in older patients.

The death rates among diabetic females tend to be lower than among diabetic males, but the difference is less than in the general population.

The survivorship rate among cases seen within a year of onset of the disease is better than in the aggregate experience.

The pattern of causes of death among diabetics has changed radically. There has been a marked increase in the proportion of deaths caused by vascular disease, with small vessel disease playing a more and more important role.

Reductions have been recorded for diabetic coma, diabetic gangrene and infections.

Analysis of causes of death by age at onset and duration of diabetes show the effect of these factors on mortality and, in particular, the outstanding importance of diabetic nephropathy in juvenile diabetics with long duration ofdisease.

Mortality from all types of vascular disorders is higher in diabetics than in the general population. In this experience the mortality for renal vascular disorders was seventeen times as high as in the general population.

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