Document is current

Article History

Received: 25 November 2025

Accepted: 23 February 2026

First Online: 21 April 2026

Acknowledgements

: We thank all the contributors to the consortium database. We thank the people with diabetes, health service staff and organisations involved in providing data and setting up, maintaining and overseeing the collation of data for people with diabetes in Scotland. Scottish data linkage was performed by the electronic Data Research and Innovation Service of Public Health Scotland with permission granted for the use of pseudonymised data for research granted by the Public Benefit and Privacy Panel and the West of Scotland research ethics committee. The Danish data were provided by The Danish Health Data Authority. We acknowledge the work of Diabetes Australia and the Australian Institute of Health and Welfare for supplying the Australian data. Data was extracted from the Alberta Health Services Enterprise Data Warehouse with support provided by AbSPORU Data and Research Services platform, which is funded by CIHR, Alberta Innovates, University Hospital Foundation, University of Alberta, University of Calgary and Alberta Health Services. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of Alberta Health Services or any of the funders.

: Aggregated data can be made available upon reasonable request to the senior authors subject to approval from the data custodians.

: Open Access funding enabled and organized by CAUL and its Member Institutions. This study was funded by the US Centers for Disease Control and Prevention (contract no. 75D30122P14242) and a Diabetes Australia Research Program (grant no. Y18G-MAGD). This work was also partly supported by the Victoria State Government Operational Infrastructure Support Program. Data for Scotland were submitted on behalf of the Scottish Diabetes Research Network epidemiology group; this network is supported by NHS Research Scotland. Datasets for Ontario were linked using unique encoded identifiers and analysed at ICES. Parts of this report are based on Ontario Registrar General (ORG) information on deaths, the original source of which is Service Ontario. This document used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from ©Canada Post Corporation and Statistics Canada. The views expressed therein are those of the author and do not necessarily reflect those of ORG or Ministry of Government Services. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and/or information compiled and provided by CIHI and the Ontario Ministry of Health. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of ICES, CIHI, the MOH or MLTC; no endorsement is intended or should be inferred. JIM is supported by a Heart Foundation Postdoctoral Fellowship (ID 108269-2024) from the National Heart Foundation of Australia. KJA is funded by ARC Laureate Fellowship FL190100011. MG is supported by the Foundation de France. EWG was supported by Science Foundation Ireland (grant no. 22/RP/10091) at Royal College of Surgeons in Ireland. JES and DJM are supported by National Health and Medical Research Council Investigator Grants. PK is supported by a Tier 1 Canada Research Chair, a Canadian Institutes of Health Research (CIHR) Sex and Gender Science Chair in Diabetes, and a Heart & Stroke Chair in Cardiovascular Research. The opinions, results and conclusions reported in this paper are those of the authors alone and are independent from all the aforementioned sources of funding and support.

: HS reports receiving personal fees for statistical consulting unrelated to this work from Novartis, MSD (Merck Sharpe & Dohme), Neumirna, Vesper Bio Aps, Oslo Economics and NHTA. DJM is a member of the Editorial Board of Diabetologia and had no involvement in the peer review or editorial decision-making for this manuscript. The authors declare that there are no other relationships or activities that might bias, or be perceived to bias, their work.

: DJM, EWG and JES conceived the study and made contacts with contributing centres. DJM, LC and KM oversaw the practical gathering of data from the centres. LC was responsible for maintaining the database. JIM, DJM and BC designed and undertook the statistical analysis and KM collated the statistical analysis output. KM wrote the manuscript. All other authors curated data from centres into the standardised form. All authors contributed to data interpretation and critical evaluation, contributed to the editing of the report, and approved the final submitted version of the manuscript. DJM, LC and JIM verified the data and had access to raw data (aggregate). DJM, LC and JIM are guarantors of data and analysis integrity.