In Reply We thank Gerrits et al for their thoughtful comments and their further inquiry to better understand the driving force behind the disparate mortality trends among patients with vs without diabetes observed in our study.1
The authors suggest that reductions in mortality related to cardiovascular causes could explain our results. Our study controls for the presence of comorbidities such as hypertension, peripheral vascular disease, and congestive heart failure, as well as for the principal diagnosis of the hospitalization. Thus, we may have been able to account at least partially for any improvements in cardiovascular complications. Nonetheless, we agree it is certainly possible that improved management of cardiovascular disease among patients with diabetes may have contributed to the disproportionate decline in inpatient mortality among this population. Gregg et al2 recently found that the incidence of diabetes-related complications has dropped substantially in the United States over the period of our study and that the decline in cardiovascular complications was greater among patients with diabetes than among those without. Of note, our study takes place during a period in which there was also increasing emphasis on glucose control, which may also have played a role.
Butala NM, Johnson BK, Horwitz LI. Mortality Trends in Diabetes Mellitus—Reply. JAMA Intern Med. 2015;175(3):470. doi:10.1001/jamainternmed.2014.8000