© 2017, © The Author(s) 2017. Objective: The objective of this study is to investigate relationships between adherence to recommended screening and medication use and severe macrovascular complications and all-cause mortality among persons aged above 68 years with diabetes mellitus (DM). Method: Data came from a 5% Medicare claims sample of beneficiaries initially diagnosed with DM during 2006-2008; follow-up was up to 7 years. Results: Adherence to screening guidelines led to reduced mortality—hazard ratio (HR) = 0.57, 95% confidence interval [CI] = [0.56, 0.58] ; congestive heart failure [CHF], HR = 0.89, CI = [0.87, 0.91] ; acute myocardial infarction [AMI], HR = 0.90, CI = [0.85, 0.95] ; and stroke/transient ischemic attack [Stroke/TIA], HR = 0.92, CI = [0.87, 0.97] —during follow-up. Recommended medication use led to lower mortality: HR = 0.72, CI = [0.70, 0.73]; CHF, HR = 0.67, CI = [0.66, 0.69] ; AMI, HR = 0.68, CI = [0.65, 0.71]; and Stroke/TIA, HR = 0.79, CI = [0.76, 0.83] . Discussion: Elderly persons newly diagnosed with diabetes who adhered to recommended care experienced reduced risk of mortality and severe macrovascular complications.