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over the last two decades several studieshave highlighted the importance of intensive glucose lowering therapy, blood pressure controland statin use to reduce the risk of cardiovascular complications and mortality in patients withdiabetes. but the long-term trends of mortalityand cardiovascular outcomes of patients with type 1 or type 2 diabetes as compared with thegeneral population are unknown. in a study of patients enrolled between 1998and 2012 in the swedish national diabetes register, a total of 36,869 patients withtype 1 and 457,473 patients with type 2 diabetes were included with along matched controlsfrom the general population. the outcomes that were assessed were all-causemortality, fatal coronary heart disease, fatal

cardiovascular disease, and hospitalizationfor cardiovascular disease. the rate of all-cause mortality declined amongthose with type 1 diabetes by 29% and in matched controls by 23%, a difference that was not statisticallysignificant. the rate of hospitalization for cardiovasculardisease decreased by 36% among those with type 1 diabetes and by 9% among matched controls,a decrease that was significantly greater for the diabetic group. the rate of all-cause mortality decreasedby 21% among those with type 2 diabetes and by 31% among matched controls, astatistically significant difference that favoured the control group.

the rate of hospitalization for cardiovasculardisease decreased by 44% among those with type 2 diabetes and by 29% among matched controls,a statistically significant difference that favoured those with type 2 diabetes. the authors conclude that mortality and cardiovasculardisease have declined for patients with diabetes. for most cardiovascular outcomes studied,event rates have decreased at least as quickly

for patients with diabetes as for matchedcontrols. however, compared to matched controls, patientswith type 2 diabetes had a smaller reduction in fatal cardiovascular outcomes. full study results are available at nejm.org