The prevalence of diabetes mellitus is increasing, partly as a result of increasing overweight and obesity predisposing to Type 2 diabetes across ages and also due to demographic change. As the incidence of diabetes predominantly Type 2 is higher in older age groups, the increasing proportion of older adults in countries worldwide will drive the diabetes epidemic. Microvascular and macrovascular complications contribute to the higher morbidity and mortality associated with diabetes. The diabetes-associated reduction in life expectancy is clearly demonstrated in middle-aged adults, as is the cumulative impact of diabetes combined with prevalent cardiovascular disease. Of note the influence of diabetes on cardiovascular events and mortality in the expanding demographic of older adults is less well characterised. In older men, increasing duration of diabetes predicts stable increases in all-cause deaths and deaths related to myocardial infarction (MI) and a progressively higher risk of stroke deaths. Increased longevity does not protect against the higher risk of death, MI and stroke associated with diabetes, once diabetes has been present for longer than five years. By contrast, prior MI is associated with increased risk of subsequent MI, and prior stroke with subsequent stroke, particularly in the 10–20 years following the first event. Thus diabetes represents a duration-dependent risk factor for cardiovascular events which influences outcomes differently from prior vascular disease. Examining the behavioural, physical and biochemical characteristics associated with diabetes in at older ages has been informative. In older men, diabetes is associated with poorer self-perceived health, reduced healthy lifestyle behaviours and physical function, and with injurious falls. The majority of these men with diabetes had good glycaemic control as defined by HbA1c concentrations. Such findings support future interventional studies to encourage healthy lifestyle behaviours and improve physical function in order to benefit quality-of-life and health outcomes in older adults with diabetes.