Diabetes is an increasing health problem in African countries. This study was undertaken to ascertain differences in the demography of diabetes in rural and urban populations, and to assess mortality, following a programme aiming to decentralise care to Health Centres nearer to patient's homes. The study population comprised 871 diabetic patients registered in Gondar between June 1995 and August 2000. Four hundred and thirty two were town residents and 439 came from remote rural areas. Most of the rural patients (77%) had Type 1 diabetes whereas in urban areas only 29% had Type 1 and 71% Type 2 diabetes. Review of the mortality of Type 1 diabetic patients up to August 2000 shows that 117 (32%) have died at a mean age of 32.0+/-10.4 years, and a duration of diabetes 6.1+/-5.0 years. Of the 871 patients, 729 are under regular review from Gondar: the care of 82 percent of the rural patients has been decentralised and is now undertaken in village health centres nearer to their homes. The management of chronic disorders such as diabetes in rural African communities needs to be decentralised to improve access to treatment and reduce mortality. The patients could achieve better health if methods of tracking non-attenders were developed, and if the need to travel large distances at frequent intervals to obtain insulin supplies could be eliminated.