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All Austrian patients with insulin dependent diabetes diagnosed between 1979 and 1990 and age at onset below 15 years were followed from manifestation until death or until 31 December 1990 by cross linking the diabetes registry data with the National Mortality database (death certificates). Out of the cohort consisting of 1185 cases, 6 had died during the study period, resulting in a standardized mortality ratio of 1.53 for the total cohort. Of the patients 50% died due to acute diabetic complications including 2 children at onset of the disease. The risk for premature death in this cohort of very young insulin dependent diabetes mellitus patients was only slightly increased. In comparison to previous studies it is rather low, but comparable to recent investigations in northern Europe. ConclusionAlthough the mortality of diabetic children and adolescents in Austria is only marginally higher than in nondiabetics, there are still deaths which should be preventable in this age group.