The Certification of Fatalities Related to Diabetes Mellitus: A Shot in the Dark?

Worldwide, an estimated 415 million people have diabetes mellitus, which results in extensive morbidity and mortality. In order to track the effect of diabetes on mortality statistics, deaths in which diabetes mellitus caused or contributed to death must be recognized, included on the death certificate, and then properly coded for vital statistic purposes. For public health policy, this will help determine the extent of the disease and follow whether deaths increase or decrease. There is variation among death certifiers for when and how diabetes is included on the death certificate and among vital records bureaus as how to code diabetes-related deaths. Case scenarios are presented to highlight the certification issues that arise with deaths related to diabetes mellitus. This area of death certification may benefit from a consensus effort to standardize and enhance certification and coding of deaths due to diabetes in order to improve the reliability of these mortality statistics.