In the majority of the high-income countries analyzed, a reduction in all-cause mortality in diabetes has been observed. A more rapid decrease in mortality occurred in people with diabetes vs those without diabetes, according to eight of 19 data sources analyzed. Continued improvement in prevention and management of diabetes is needed to obtain further longevity gains.

• In this retrospective, multicountry analysis, researchers analyzed aggregate data from 19 data sources in 16 high-income countries or jurisdictions for the span from Jan 1, 1995, to Dec 31, 2016, (or a subset of this period) on all-cause mortality in individuals with diagnosed total or type 2 diabetes.

• During 0·5 billion person-years of follow-up, nearly 21 million deaths occurred in people with diagnosed diabetes.

• In diabetics, reductions in the age-standardized and sex-standardized mortality was evident in 17 of 19 data sources; annual percentage alteration in mortality ranged from –0·5% in Hungary to –4·2% in Hong Kong.

• The east and southeast Asia showed the largest decreases in mortality, with a change of –4·2% in Hong Kong, –4·0% in South Korea, –3·5% in Taiwan, and –3·6% in Singapore.

• Between persons with and without diabetes, annual estimated change in standardized mortality ratio (SMR) ranged from –3·0% (US Medicare) to 1·6% (Lombardy, Italy).

• In the 17 data sources with decreasing mortality among diabetics, a significant SMR elevation was evident in five data sources, there was no significant SMR change in four data sources, and a significant SMR decline was seen in eight data sources.