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June 2, 1999

Screening for Type 2 Diabetes—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(21):1986-1988. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-21-jbk0602

In Reply: Drs Goyder and Irwig suggest that our model may overestimate the risk of end-stage microvascular disease for the screened population because some subjects may die of CVD before end-stage microvascular disease develops. This is correct to the extent that the CVD mortality rate we used for the lead time period (after screening and before clinical diagnosis) may be conservative. The Framingham Heart Study diabetes mortality risk adjustment was applied after the lead time period in both the screened and unscreened populations.1 However, we did not apply this adjustment to the screened population during the lead time period. If the mortality rate during this period is actually higher, the lifetime incidence of microvascular complications in both populations and the benefit of screening would be reduced.

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