Objective. To determine the mortality of insulin-dependent diabetes mellitus in the age group of 0-19 year over the period 1988-1990 and to compare these data with those of ten years ago. Design. Retrospective. Setting. The Netherlands. Method. The number of deaths was obtained by using the data of the death certificate registers of the Central Bureau of Statistics and the Netherlands Centre for Health Care Information. The data of both independent sources were compared. Supplementary data were supplied by all the physicians in charge. Results. Five chilren with diabetes as the primary cause of death, in 7 others diabetes was the secondary cause. Eight of these twelve children diet outside the hospital. Three children died at onset of IDDM. Compared with ten years earlier the risk of dying with IDDM as primary cause of death decreased (from 0.96 to 0.43 per 106 0.19-year-olds per 3-year period). It was especially the onset of mortality risk that decreased (from 0.75% to 0.20%), mainly due to decreased onset mortality in the hospital. Conclusion. Despite an increased incidence of IDDM in the Netherlands the number of diabetic children who died has decreased. Early diabetes-related mortality is mainly caused by acute diabetic complications, which must be considered preventable.