In Reply: In response to Drs Leibson and Narayan,
we agree that the use of self-reported diabetes status might lead to the detection
of milder diabetes in later periods because of heightened awareness and increased
screening. However, this same increased awareness of diabetes might also lead
to overattribution of diabetes in CVD-related deaths on death certificates.
We agree that the overall burden of CVD due to diabetes is increasing, likely
because of increases in the overall prevalence of diabetes. This is a different
issue from the one we address in our analysis.
Fox CS, Sorlie PD, Savage PJ. Trends in Cardiovascular Complications of Diabetes—Reply. JAMA. 2005;293(14):1723–1724. doi:10.1001/jama.293.14.1723-b
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