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Although cardiovascular disease is long established as the commonest cause of death in people with diabetes, things may be changing. In an analysis of data from two Canadian provinces and nine other high income settings, cardiovascular mortality fell and dementia mortality rose between 2000 and 2023 ( Lancet Diabetes Endocrinol doi:10.1016/S2213-8587(25)00398-5). By the end of this period, cancer had become the leading cause of death among people with diabetes in four of the 11 areas.