How Many People Die From Diabetes Each Year?

Diabetes kills roughly 338,000 people prematurely each year in the United States alone, according to a 2022 economic analysis that tallied lost productivity from early death.¹ Globally, the toll is far higher, with estimates from public health organizations placing the worldwide figure in the millions annually. But the true number is almost certainly larger than any official statistic suggests, because diabetes is systematically undercounted on death certificates. Understanding why the count is so slippery, and what actually kills people with diabetes, matters more than fixating on a single headline figure.

Why the Official Count Is Almost Certainly Too Low

When someone with diabetes dies of a heart attack, the death certificate often lists heart disease as the cause and may not mention diabetes at all. This pattern plays out across nearly every complication diabetes can cause. Research has long flagged this problem, noting that diabetes ranks as a leading cause of death in U.S. adults but that the figure is likely an underestimate because of chronic under-reporting on death certificates.² The person filling out the certificate, usually the attending physician, has to decide which single condition was the “underlying” cause of death. When diabetes contributed to a fatal stroke or kidney failure but was not the immediate trigger, it often gets left off entirely.

This matters because the gap between “deaths where diabetes was the underlying cause” and “deaths where diabetes was listed anywhere on the certificate” is enormous. During the first two years of the COVID-19 pandemic, for example, deaths listing diabetes as one of multiple causes were nearly 48% above expected levels, but deaths listing diabetes as the underlying cause were only about 18% above expected.³ That difference reflects how regularly diabetes gets demoted from the primary line on the form. In effect, if you only count deaths officially “caused by” diabetes, you miss a huge share of the people whose diabetes contributed to or accelerated their death.

What Actually Kills People With Diabetes

Diabetes rarely kills through high blood sugar alone. Instead, it damages blood vessels, nerves, and organs over years, creating the conditions for fatal events that get attributed to other diseases. The biggest of these is cardiovascular disease. Large cohort studies in the Asia-Pacific region have found that among thousands of deaths in populations with diabetes, cardiovascular disease accounted for a substantial share of the total.⁴ In analyses of people diagnosed with type 2 diabetes at different ages, cardiovascular deaths accounted for roughly 30 to 45% of the reduction in life expectancy compared to people without diabetes.⁵

Kidney disease is another major pathway. People with both type 2 diabetes and kidney disease have dramatically higher mortality than those with diabetes alone. One study found that standardized mortality among people with both conditions was about 31%, representing an absolute risk difference of more than 23 percentage points compared with people who had neither condition. The researchers concluded that kidney disease predominantly accounts for the increased mortality observed in type 2 diabetes.⁶ The situation is even more severe for people who progress to end-stage kidney disease: mortality rates among those with both end-stage kidney disease and diabetes can be more than 15 times higher than among those with end-stage kidney disease alone.⁷

Infection is an underappreciated contributor. People with type 2 diabetes face both larger absolute and larger relative risks of dying from sepsis compared to people without diabetes, and the gap is especially pronounced in those under 75.⁸ Diabetes weakens immune responses and impairs wound healing, which means infections that a healthy person might fight off can become life-threatening.

Acute Crises That Can Turn Fatal

Not all diabetes deaths are slow. Hyperglycemic crises, including diabetic ketoacidosis and hyperosmolar hyperglycemic state, can kill within hours or days. In the United States, deaths from hyperglycemic crises nearly doubled over two decades, rising from about 3,300 deaths in 1999 to over 6,000 in 2019.⁹ These are not obscure events. Diabetic ketoacidosis alone accounted for over 71,000 deaths in the U.S. between 2006 and 2021.¹⁰

The mortality risk from these crises differs sharply by age. In children and adolescents, in-hospital mortality from diabetic ketoacidosis is low, about 0.1%, though ICU admission rates are high and cerebral edema remains a dangerous complication. In adults aged 20 and older, the in-hospital mortality rate jumps to about 4% across both types of diabetes.¹¹ These are preventable deaths in many cases, often triggered by missed insulin doses, infections, or lack of access to care.

The Life Expectancy Gap Between Type 1 and Type 2

The mortality burden of diabetes looks very different depending on which type a person has. A 2025 meta-analysis found that life expectancy for men with type 1 diabetes averaged about 65 years, and for women about 68 years, compared to roughly 80 and 84 years respectively for people without diabetes. That translates to about 11 fewer years of life for men and 11 fewer for women with type 1 diabetes.¹² This gap has narrowed considerably over time. A longitudinal cohort study found that life expectancy for people diagnosed with type 1 diabetes between 1965 and 1980 was about 69 years, a gain of more than 15 years over those diagnosed between 1950 and 1964.¹³

The picture varies enormously by country. A modeling study estimated that a 10-year-old diagnosed with type 1 diabetes in 2021 could expect about 65 more years of life in a high-income country but only about 13 more years in a low-income country.¹⁴ The researchers also estimated millions of “missing” prevalent cases worldwide, meaning people who should still be alive with type 1 diabetes but died prematurely due to lack of insulin access and basic medical care.

For type 2 diabetes, the gap depends heavily on how well a person manages multiple risk factors. A study tracking people with type 2 diabetes found that those who had six or seven risk factors within target range at age 50 lost less than one year of life expectancy compared to people without diabetes. But those with zero or one factor in target range lost nearly eight years.¹⁵ This is a striking finding: well-managed type 2 diabetes may carry nearly the same life expectancy as no diabetes at all.

When Diabetes Starts Young, the Mortality Risk Multiplies

Age at diagnosis is one of the strongest predictors of how much life diabetes takes away. A large study using U.S. data found that people diagnosed with type 2 diabetes before age 40 had roughly 2.7 times the risk of dying from any cause compared to those diagnosed at 60 or older, and about the same elevated risk for cardiovascular death specifically.¹⁶ An analysis using data from multiple countries put the numbers in even starker terms: at age 50, someone diagnosed with type 2 diabetes at 30 had died, on average, about 14 years earlier than someone without diabetes. For diagnosis at 40, the gap was about 10 years; for diagnosis at 50, about 6 years.⁵

Youth-onset type 2 diabetes appears to follow a more aggressive clinical course than either adult-onset type 2 or type 1 diabetes.¹⁷ This is worrying because type 2 diabetes in teenagers and young adults has been increasing in many countries. More years of elevated blood sugar means more years for complications to develop, and the organs sustaining damage, especially the kidneys and blood vessels, are getting hit at an age when they would normally still be healthy.

U.S. Mortality Trends Over Time

The trajectory in the United States has not been a simple story of progress. Looking at the broadest time frame, diabetes caused over three million deaths among U.S. adults between 1968 and 2022, with the overall age-adjusted mortality rate declining slightly over that entire span.¹⁸ But zooming into the more recent period tells a different story. The age-adjusted mortality rate for type 2 diabetes specifically more than doubled between 1999 and 2023, rising from about 22 per 100,000 to about 54 per 100,000, with a total of over two million deaths attributed to type 2 diabetes in the U.S. during that 25-year period.¹⁹

These two findings are not contradictory. The five-decade trend captures an era when cardiovascular mortality plummeted across the entire population thanks to statins, blood pressure medications, and reduced smoking. Some of that benefit flowed to people with diabetes. But the more recent acceleration reflects surging obesity rates, the growing diabetes population, and possibly better identification of diabetes as a contributing cause on death certificates. The sharpest jump came between 2018 and 2021, likely amplified by the pandemic.

The Developing World Carries a Heavier Burden

Globally, mortality rates from diabetes have followed different arcs in different parts of the world. A trend analysis covering 1990 to 2019 found that developing countries had a lower diabetes incidence rate but a higher mortality rate and a higher mortality-to-incidence ratio than developed countries. The mortality rate in developing countries was about 15 per 100,000 higher than in developed countries at baseline, and the gap persisted through much of the study period.²⁰ In other words, fewer people per capita were being diagnosed, but a larger share of those diagnosed were dying. This pattern points directly to gaps in health care access, medication availability, and screening. In wealthier nations, the mortality-to-incidence ratio declined at roughly twice the rate it did in developing countries over the same period.²¹

The COVID-19 Spike

The pandemic created a visible spike in diabetes-related deaths. Between March 2020 and March 2022, the U.S. saw an estimated 270,000 excess deaths in which diabetes was listed as one of the multiple causes on the death certificate, and about 34,000 excess deaths where it was the underlying cause.³ People with diabetes were at higher risk of severe COVID-19 outcomes, but the pandemic also disrupted routine care. Missed appointments, deferred screenings, and insulin access problems all contributed.

Acute emergencies spiked too. Diabetic ketoacidosis deaths showed excess mortality of about 37% in 2020 and 47% in 2021 compared to pre-pandemic trends, while hyperosmolar hyperglycemic state deaths were about 41% and 57% above expected in those same years.¹⁰ Cardiovascular deaths related to diabetes also surged: 2020 saw about a 16% increase in diabetes-related cardiovascular mortality compared to 2019, with an estimated 16,000 excess deaths of this type, most due to ischemic heart disease.²²

Racial and Ethnic Disparities

Diabetes deaths are not distributed evenly across racial and ethnic groups. In the U.S., American Indian and Alaska Native populations bear an extremely high burden of diabetes mortality, driven by longstanding inequities in access to health care, socioeconomic status, and the lasting effects of structural racism. Black and Latino populations also face higher diabetes death rates than the white population, shaped by similar patterns of unequal access and higher uninsured rates.²³

The gaps persist even within the same cities. An analysis of the 50 most populous U.S. cities found that racial economic inequality, specifically the ratio of Black to white poverty, had the greatest impact on the disparity in diabetes mortality between racial groups. Adjusting for both economic inequality and residential segregation explained nearly three-quarters of the observed gap.²⁴ The specific complications also differ by group. One retrospective study found that Black patients had the highest rates of ketoacidosis and neurological complications, while Asian and Pacific Islander patients had the highest rates of hypoglycemia and kidney complications, and Hispanic patients had the highest rates of circulatory complications.²⁵ These patterns mean the path from diabetes to death looks different depending on who you are and where you live.

Newer Medications and Their Impact on Mortality

Two classes of diabetes drugs that have gained widespread use over the past decade, SGLT2 inhibitors and GLP-1 receptor agonists, now have strong evidence of reducing death in people with type 2 diabetes. A systematic review and network meta-analysis of randomized controlled trials found that both classes lowered all-cause mortality, cardiovascular mortality, heart attacks, and kidney failure, with high-certainty evidence.²⁶

A large observational study of diabetic patients with cardiovascular disease found especially dramatic associations: patients on SGLT2 inhibitors alone had about 72% lower all-cause mortality compared to patients on neither drug, those on GLP-1 receptor agonists alone had about 61% lower mortality, and those on both medications had about 83% lower mortality.²⁷ These observational numbers are likely inflated by selection bias, since healthier and more engaged patients tend to get newer medications, but even the randomized trial evidence shows meaningful reductions. When compared head to head, the two drug classes appear similar in their effects on mortality.²⁸

The challenge, of course, is that the people who stand to benefit most from these medications are often the least likely to have access. In the U.S., cost-related insulin rationing remains a documented problem among adults with diabetes, particularly in vulnerable populations without adequate insurance.²⁹ Newer medications tend to be more expensive still, and global availability varies enormously.

When Amputation Enters the Picture

Diabetes-related lower limb amputation is one of the most feared complications, and its association with subsequent mortality is sobering. A literature review found that 30-day mortality rates after lower extremity amputation ranged from about 7% to over 50% depending on the study, with an average around 16%. One-year mortality rates ranged from about 9% to 64%, averaging roughly 33%.³⁰ A study tracking patients long-term after below-knee amputation found that about 71% of patients had died during the follow-up period, with a median survival of roughly two and a half years after surgery.³¹ Another long-term study found survival rates of 64% at one year, 50% at three years, 40% at five years, and just 24% at ten years following amputation, with the highest concentration of deaths occurring within the first four months.³²

These numbers reflect how far the disease has progressed by the time amputation becomes necessary. By that point, the same vascular damage causing foot problems has usually already affected the heart and kidneys. Amputation is more a marker of advanced disease than an independent cause of death, but it signals a dramatically shortened remaining lifespan.

Diabetes in Pregnancy

Gestational diabetes and pre-existing diabetes during pregnancy both raise the risk of severe maternal outcomes. A U.S. analysis found that pregnant women with diabetes were about three times more likely to experience cardiac arrest and about three times more likely to die in the hospital compared to pregnant women without diabetes.³³ The risk of early delivery was also elevated. While maternal death from diabetes in pregnancy remains uncommon in absolute terms, the threefold increase in risk makes it a meaningful contributor to maternal mortality in a country where pregnancy-related death rates have been rising.

Beyond the immediate pregnancy, gestational diabetes also signals elevated long-term risk. Women who develop gestational diabetes have a substantially higher lifetime chance of progressing to type 2 diabetes, which reintroduces all of the chronic mortality risks discussed earlier. The pregnancy itself can be thought of as a stress test that reveals underlying metabolic vulnerability.

1
Diabetes Care. Economic Costs of Diabetes in the U.S. in 2022
2
PubMed Central. Sensitivity and Specificity of Death Certificates for Diabetes: As Good as it Gets?
3
PubMed Central. Temporal variation of excess deaths from diabetes during the COVID-19 pandemic in the United States
4
Diabetes Care. The Effects of Diabetes on the Risks of Major Cardiovascular Diseases and Death in the Asia-Pacific Region
5
The Lancet. Age at diagnosis of type 2 diabetes and associations with all-cause and cause-specific mortality and potential life expectancy
6
PubMed Central. Kidney disease and increased mortality risk in type 2 diabetes
7
Archives of Medical Science. The association of diabetes with all-cause mortality in patients with end-stage renal disease compared to the general population in Poland
8
The Lancet Regional Health – Europe. Contribution of infection to mortality in people with type 2 diabetes: a population-based cohort study using electronic records
9
JAMA. Mortality Due to Hyperglycemic Crises in the US, 1999-2022
10
PubMed Central. Trends in diabetic ketoacidosis- and hyperosmolar hyperglycemic state-related mortality during the COVID-19 pandemic in the United States: A population-based study
11
PubMed Central. Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study
12
PubMed Central. Life expectancy in individuals with type 1, type 2 diabetes and without diabetes: a systematic review and meta-analysis
13
Diabetes. Improvements in the Life Expectancy of Type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complications Study Cohort
14
The Lancet Diabetes & Endocrinology. Global incidence, prevalence, mortality, and life expectancy of type 1 diabetes in 2021 and estimation of 2040: a modelling study
15
PubMed Central. Assessing the impact of type 2 diabetes on mortality and life expectancy according to the number of risk factor targets achieved: an observational study
16
Scientific Reports. Age at type 2 diabetes diagnosis and the risk of mortality among US population
17
PubMed Central. Youth-onset type 2 diabetes mellitus: an urgent challenge
18
Diabetes. The Rise and Fall of Diabetes Mortality—U.S. Trends across Five Decades (1968–2022)
19
PubMed Central. Type 2 Diabetes Mellitus–Related Mortality in the United States, 1999 to 2023
20
PubMed Central. Global trend analysis of diabetes mellitus incidence, mortality, and mortality-to-incidence ratio from 1990 to 2019
21
Scientific Reports. Global trend analysis of diabetes mellitus incidence, mortality, and mortality-to-incidence ratio from 1990 to 2019
22
PubMed Central. Impact of the COVID-19 Pandemic on Diabetes-Related Cardiovascular Mortality in the United States
23
Diabetes Care. The Burden of Diabetes Mortality by County, Race, and Ethnicity in the U.S., 2000–2019
24
PubMed Central. Racial Disparities in Diabetes Mortality in the 50 Most Populous US Cities
25
Diabetology. Racial and Ethnic Disparities in Type 2 Diabetes Complications and In-Hospital Mortality in the United States: A Retrospective Cohort Study
26
The BMJ. Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials
27
PubMed Central. SGLT2 inhibitors and GLP-1 receptor agonists: impact on mortality in diabetic patients with cardiovascular disease
28
PubMed. Kidney and Cardiovascular Effectiveness of SGLT2 Inhibitors vs GLP-1 Receptor Agonists in Type 2 Diabetes
29
PubMed. Economic Costs of Diabetes in the U.S. in 2022
30
PubMed Central. Life Expectancy and Mortality After Lower Extremity Amputation: Overview and Analysis of Literature
31
PubMed Central. Factors affecting lifespan following below-knee amputation in diabetic patients
32
PubMed. Survival at 10 years following lower extremity amputations in patients with diabetic foot disease
33
PubMed. Diabetes in pregnancy and risk of near-miss, maternal mortality and foetal outcomes in the USA: a retrospective cross-sectional analysis