OBJECTIVEDespite its growing prevalence in China, the extent to which diabetes leads to excess cardiovascular disease (CVD) mortality and all-cause mortality is unclear.RESEARCH DESIGN AND METHODSWe compared death rates and causes of death among 630 people with newly diagnosed diabetes (NDD) and 519 with normal glucose tolerance (NGT) who, in 1986, were identified as a result of screening 110,660 adults aged 25-74 years for diabetes in Da Qing, China.RESULTSDuring 23 years of follow-up, 338 (56.5%) participants with NDD and 100 (20.3%) with NGT died. CVD was the predominant cause of death in those with diabetes (47.5% in men and 49.7% in women), almost half of which was due to stroke (52.3% in men and 42.3% in women). The age-standardized incidence of all-cause death was three times as high in those with NDD as in those with NGT with incidences (per 1,000 person-years) of 36.9 (95% CI 31.5-42.3) vs. 13.3 (10.2-16.5) in men (P < 0.0001) and 27.1 (22.9-31.4) vs. 9.2 (7.8-10.6) in women (P < 0.0001). The incidence of CVD deaths in men and women with NDD (17.5 [13.8-21.2] vs. 13.5 [10.5-16.5]) did not differ significantly. Significantly higher death rates attributable to renal disease and infection were also found in the NDD group.CONCLUSIONSDiabetes is associated with a substantially increased risk of death in Chinese adults, especially from CVD, almost half of which is due to stroke.