The prevalence of youth onset type 2 diabetes (T2DM) is increasing. However few data are available on long term complications or mortality outcomes in this group. As diabetes care in youth is largely focused on type 1 diabetes, it would be important to understand comparative outcomes in these two groups so that intervention strategies may be better targeted. We examined diabetes complication and survival outcomes in 354 patients with T2DM of onset between 15 and 30 years (T2³⁰) and in 354 patients with T1DM matched for age of onset (T1³⁰). Mortality data were obtained by data matching with the National Death Index and censored at 2011. While glycaemic exposure and retinopathy were not different between the groups, T2³⁰ had higher neuropathy scores and albuminuria (p<0.0001 for both). T2³⁰ show an excess of IHD (p<0.0001), stroke (p<0.008) compared to T1³⁰. Despite a greater use of statins and antihypertensives (both p<0.0001), the risk factors of systolic BP, Tg, HDL and BMI were all worse in T2³⁰ (Table 1). There were 39 vs 23 deaths in the T2³⁰ and T1³⁰ groups respectively (p=0.03) and risk ratio for death was 2.4 [1.3-4.1] (p=0.003) in the T2³⁰ group by Cox regression analysis. Kaplain Meier analysis shows a significantly reduced cumulative survival in T2³⁰ (Fig 1, p=0.047) who died after a shorter duration of diabetes (26.9 vs 35.4 yrs, p=0.07) and more from vascular death (p=0.047). By matching the same age range for diabetes onset, this study has been able to compare the detrimental long term effects of youth onset T2DM and T1DM, minimizing the otherwise unavoidable confounding effects of age and diabetes duration. These data are evidence for the greater metabolic derangement and long term detrimental effects of youth onset T2DM, highlighting this group for aggressive intervention.