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"Although our analyses indicate encouraging reduction in mortality and, indirectly, continued success in diabetes care, these findings have ironic implications for the future U.S. diabetes burden. Death rates, along with earlier detection of undiagnosed diabetes and incidence of new diabetes cases, are the principal determinants of future diabetes prevalence and the disease and economic burden that follows. Recently published models indicate thatdeclining mortality among people with diabetes can lead to a substantial increase in prevalence (24,25). Studies from national registries in Denmark, Sweden, and provincial registries in Canada portray a similar picture, wherein the death rate has declined sufficiently so that prevalence is likely to continue to increase even if incidence trends flatten (18,26). Thus, the excess mortality associated with diabetes, though declining, will be spread among a considerably greater proportion of the population. Ultimately, this means that the need for vigilant efforts to prevent vascular and neuropathic complication and early mortality associated with diabetes along with efforts to reduce diabetes incidence will continue to be major demands into the future."