Background and Aims: to investigate the risk of mortality from infections by comparing the 33 underlying causes of death versus the multiple causes of death in known diabetic subjects living in 34 the Veneto Region, Northern Italy. 35 Methods and Results: 185,341 diabetic subjects aged 30-89 years were identified in the year 2010 36 and causes of death were assessed from 2010 to 2015. Standardized Mortality Ratios (SMR) with 37 95% confidence intervals were computed with regional mortality rates as reference. The underlying 38 causes of death and all the diseases reported in the death certificates were scrutinized. At the end of 39 the follow-up, 36,382 subjects had deceased. We observed an increased risk of death from 40 infection-related causes in subjects affected by diabetes with a SMR of 1.83 (95 % CI, 1.71-1.94). 41 The SMR for death from septicemia was 1.91 (95 % CI, 1.76-2.06) and from pneumonia 1.47 (95 % 42 CI, 1.36-1.59). The use of the multiple causes of death approach emphasized the contribution of 43 infectious diseases to mortality. 44 CONCLUSION: the results of the present study demonstrate an excess mortality from infection45 related diseases in patients affected by diabetes and, more interestingly, show a possible 46 underestimation of the impact of these conditions by routine mortality analyses
