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Comment & Response
October 15, 2019

Reasons for Increases in Complications of Diabetes

Author Affiliations
  • 1School of Medicine, University of North Carolina, Chapel Hill
JAMA. 2019;322(15):1518-1519. doi:10.1001/jama.2019.13036

To the Editor Dr Gregg and colleagues1 identified a resurgence in diabetes complications in the United States beginning in 2010 and analyzed potential underlying contributors and policy implications. However, there may be another underlying mediator of the effect that the authors did not consider.

There has been a decline in the incidence of diabetes that began in approximately 2009.2,3 With changes in the diagnostic criteria and emphasis on screening for diabetes over the last 2 decades, US clinicians likely diagnosed a large number of previously unrecognized cases in the earlier part of this century. This increased identification may have artifactually reduced the rate of complications because of a bolus of relatively early cases of diabetes. Now that diagnostic behaviors are more stable, the proportion of recently diagnosed patients among the population with diabetes is less than a decade ago, leading to the appearance of a phenotype of more complications.