OBJECTIVETo investigate infection-related mortality in individuals with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODSA total of 1,108,982 individuals with diabetes who were registered with the Australian Diabetes register between 2000 and 2010 were linked to the National Death Index. Mortality outcomes were defined as infection-related A-B death (ICD codes A99-B99), pneumonia (J12-J189), septicemia (A40 and A41), and osteomyelitis (M86). RESULTSDuring a median follow-up of 6.7 years, there were 2,891, 2,158, 1,248, and 147 deaths from infection-related A-B causes, pneumonia, septicemia, or osteomyelitis, respectively. Crude mortality rates from infections A-B were 0.147 and 0.431 per 1,000 person-years in type 1 and type 2 diabetes, respectively. Standardized mortality ratios (SMRs) were higher in type 1 and type 2 diabetes for all outcomes after adjustment for age and sex. For infection-related A-B mortality, SMRs were 4.42 (95% CI 3.68-5.34) and 1.47 (1.42-1.53) for type 1 and type 2 diabetes (P < 0.001), respectively. For pneumonia in type 1 diabetes, SMRs were approximately 5 and 6 in males and females, respectively, while the excess risk was ∼20% for type 2 (both sexes). For septicemia, SMRs were approximately 10 and 2 for type 1 and type 2 diabetes, respectively, and similar by sex. For osteomyelitis in type 1 diabetes, SMRs were 16 and 58 in males and females, respectively, and ∼3 for type 2 diabetes (both sexes). CONCLUSIONSAlthough death owing to infection is rare, we confirm that patients with diabetes have an increased mortality from a range of infections, compared with the general population, and that the increased risk appears to be greater for type 1 than type 2 diabetes.Individuals with type 1 and type 2 diabetes are widely considered to be more prone to infections than those without diabetes (1). Evidence to support this hypothesis can be traced back as far as 1915 when Lichty noted a range of acute infections in patients with diabetes who subsequently died (2). Several decades later, two wellcited studies showed that bacteremia and bacteriuria are more common in adult women with diabetes versus those without (1,3). The factors thought to explain the excess risk of infections in these women were microvascular complications such as

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