Research article
Whether to report diabetes as the underlying cause-of-death? a survey of internists of different sub-specialties
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* Corresponding author: Tsung-Hsueh Lu robertlu@mail.ncku.edu.tw
1 Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2 Division of Endocrinology and Metabolism, Department of Medicine and Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
3 Faculty of Medicine and Institutes of Physiology and Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
BMC Endocrine Disorders 2010, 10:13 doi:10.1186/1472-6823-10-13
Published: 23 July 2010Abstract
Background
Cause-specific mortality is a commonly used endpoint of clinical trials or prospective studies. However, it is sometimes difficult for physician to determine the underlying-cause-of-death (UCD), especially for diabetic patients coexisted with cardiovascular diseases (CVD). The aim of this survey was to examine whether internists with different specialties have different opinions on the reporting of diabetes as the UCD.
Methods
A total of 549 physicians completed the questionnaire in Taiwan, which comprised seven hypothetical case scenarios, each indicating a different level of contribution of diabetes in initiating the chain of events leading to death.
Results
As a whole, endocrinologists were more likely than cardiologists and nephrologists to report diabetes as the UCD. The differences were more prominent when the diabetic patient had a coexisting CVD. In scenario 3 (a diabetic patient with hypertension who died from acute myocardial infarction), the percentage was 56% in endocrinologists, which was significantly higher than in cardiologists (42%) and nephrologists (41%). In scenario 4 (a diabetic patient with hypertension who died from cerebrovascular infarction), the percentage was 45% in endocrinologists, and only 31% in cardiologists and 36% in nephrologists.
Conclusions
Internists of different sub-specialties do have different opinions on the reporting of diabetes as the UCD, especially when the diabetic patient has a coexisting CVD.