Most previous work estimating survival rates for diabetes has been based on logistic regression or standardized ratios to derive odds ratios rather than being based on survival analysis with risk estimates over time. Few studies have estimated the excess risk between those with and without diabetes. OBJECTIVES: The purpose of this study was to estimate the excess risk and cumulative relative risks of death and complications between those with newly diagnosed diabetes and those without. METHODS: Newly diagnosed type 1 and 2 diabetes cases aged 35 and over were identified from the Ontario Diabetes Database and matched 1:2 using propensity scores with controls (non-diabetes cases). Using linked provincial administrative databases, data on death and the following complications were recorded: myocardial infarction, stroke, angina, heart failure, blindness, amputation, nephropathy and cataract. Kaplan Meier curves were calculated to estimate the probability of being event-free for those with and without diabetes for up to 10 years of follow-up. RESULTS: A total of 610,852 patients aged 35 and over with diabetes were matched with 1,221,704 patients without diabetes. For those with diabetes vs. those without, there was a statistically significant increased relative risk at 10 years for death (1.417, [95%] CI 1.415–1.418), myocardial infarction (2.094, [95%] CI 2.092–2.095), stroke (1.877, [95%] CI 1.874–1.879), angina (1.526, [95%] CI 1.525–1.527), heart failure (2.520, [95%] CI 2.529–2.522), amputation (6.824, [95%] CI 6.823–6.824), nephropathy (2.902, [95%] CI 2.901–2.904), blindness (1.212, [95%] CI 1.205–1.218) and cataract (1.326, [95%] CI 1.324–1.327). CONCLUSIONS: Diabetes is a significant health problem with excess risk of death and complications typically associated with diabetes. Using estimates of risk of death or complications for a general (non-diseased) population can result in significant underestimates of disease burden or cost-effectiveness in decision analytic models of disease management or prevention.