We compared life expectancy and causes of death based on death certificates of 269 diabetic participants (group A) and 5659 nondiabetic participants (group B) who died from January 1, 1991 to December 31, 2010, in 3 small towns of Northern Greece. Age at death was significantly (P = .011) higher in group A (77.2 ± 8.7 years) than in group B (75.7 ± 18.9 years). Males with diabetes lived longer with a mean difference of 4.7 (2.8-6.6) years (P < .001), whereas females without diabetes lived longer, with a mean difference of 2.3 (1.1-5.6) years (P = .004). Diabetic participants died more frequently of myocardial infarction (P = .001), chronic renal failure (P < .001), followed by pneumonia (P = .010) and hyperosmolar non-ketotic coma (P < .001). Nondiabetic participants died more frequently of lung cancer (P < .001), old age (P < .001), and car accidents (P = .004). In conclusion, the cardiovascular and renal disease burden among diabetic participants did not reduce life expectancy, especially in men.