The publication ‘Australian Institute of Health and Welfare Diabetes Australian Facts’ provides national diabetes associated mortality statistics suggesting that death rates with diabetes as the underlying cause, expressed per 100,000 population have been stable over time (1). This method of quantifying mortality does not adjust for the increasing prevalence of diabetes in the community, nor for changes in the complexity of diabetes cases, thereby potentially masking any benefit from improvements in diabetes management. We therefore examined secular trends in diabetes mortality by assessing case fatality by quadrennium in patients who have attended the Royal Prince Alfred Diabetes Centre over a 12 year period. Clinical data from last visit of each quadrennium were extracted from the RPA diabetes database and mortality ascertained by data matching with the National Diabetes Index. We observed a significant reduction in death from all causes over the three quadrennia (p=0.04), particularly in the middle to older age range (p≤ 0.04, Figure 1). This is associated with a correspondingly longer duration of diabetes (p <0.0001). There was a secular increase in the use of statin and antihypertensive treatment with a commensurate improvement in cardiovascular risk factors ACR, BP, Total cholesterol and Tg (p≤0.009 for all). Smoking prevalence also decreased over time. Notably, these mortality improvements were seen despite a deterioration or no improvement in HbA1c, BMI and HDL, prevalence of retinopathy and macrovascular disease over time. These data are evidence for the secular improvements in diabetes survival, less able to be captured by AIHW data. However, it appears that this survival benefit, presumably related to better multifactorial intervention, has not been associated with a similar decline in morbidity. This has the consequence of increasing case complexity, case load and health care demands.