Comment on Cheng et al. Trends and Disparities in Cardiovascular Mortality Among U.S. Adults With and Without Self-Reported Diabetes, 1988–2015. Diabetes Care 2018;41:2306–2315 (original) (raw)
We read with great interest the recently published article by Cheng et al. (1). The authors note that there was a dramatic increase in prevalence (age-standardized) between the 1980s and 2010 (3% and 9%, respectively) in the population with diabetes compared with the population without, along with a decrease in the excess risk of cardiovascular disease (CVD). The authors attribute this excess risk reduction to an improvement in primary and secondary diabetes care. However, it must be remembered that the diabetes diagnostic criteria have changed over the years. In 1997, the fasting blood glucose threshold for diagnosis went from 140 to 126 mg/dL, precisely in view of the increased risk of CVD in patients with blood glucose levels between 126 and 140 mg/dL (2). This change, combined with more frequent screening in the population at an everyounger age (3) and greater disease awareness in the population (4), means that self-reported diabetes no longer describes the same disease described in the 1980s. This phenomenon implies not only that some individuals with diabetes in the 1980s were included in the healthy population (which mathematically has a minimal impact on the CVD incidence comparison between the population
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