This retrospective study presents the mortality trends in diabetic patients in a developing region of the world. The data were collected by screening the hospital records of all diabetic patients who died over a period of a decade at Institute of Medical Sciences, a tertiary care medical centre in Kashmir Valley of India. Of 133,374 patients admitted to the centre from January 1987 to December 1996, 9627 died, of whom 269 (151 males and 118 females) were recorded to have diabetes mellitus. The mean+/-S.D. age at the time of death was 51.61+/-13.77 years for males and 51.50+/-15.50 years for females. The common causes contributing to death were infections (33.83%), chronic renal failure (30.85%), coronary artery disease (16.36%), cerebrovascular disease (13.75%), hypoglycaemia (7.81%), diabetic ketoacidosis (6.69%) and hyperosmolar coma (2.23%). In 7.43% patients the cause of death could not be ascertained. Death was attributed to single cause in 60.22%, to two causes in 26.39% and to three or more causes in 5.95%. Most (59.11%) of these diabetic patients died within a week of hospitalisation. We conclude that mortality trends in diabetes mellitus differ in developing regions as compared to developed regions reflecting poor healthcare in general and diabetic care in particular. Unlike in west, where the major killers in diabetic patients are coronary artery disease and cerebrovascular disease, infections and chronic renal failure continue to be leading causes of death in patients with diabetes mellitus in developing regions like ours.