Patients with lung cancer with diabetes mellitus have an increased survival compared with those without diabetes mellitus.

We appreciate your interest in our article published in the Journal of Thoracic Oncology 1 and thank you for the opportunity to answer your questions. In our article, we analyzed the influence of diabetes mellitus on the survival of patients with lung cancer. We found that lung cancer patients with diabetes mellitus had a longer survival compared with patients without diabetes mellitus. The mean age at baseline in the Nord-Trøndelag Health Study (HUNT) for patients with lung cancer was 59 years, and 4.5% among these had self-reported diabetes mellitus. Similar prevalence has been reported in other studies for comparable age groups, 2 and these estimates are also in line with the prevalence in the total HUNT study population at this age. 3,4 The mean age at the time of diagnoses of lung cancer was 70 years. In the HUNT study, diabetes mellitus was defined by the answer "yes" to the question "Do you have or have you had diabetes?" independent of whether or not the person used medication for diabetes mellitus. Self-reported diabetes mellitus is a widely accepted and used tool in epidemiological studies. 5 The question on self-reported diagnosis has also been validated in the HUNT study population. 6 We therefore believe that our definition of the variable "diabetes mellitus" can be used in the current setting. Dr. Satoh is of course right regarding change in the treatment of diabetes mellitus in the last decades. We agree that information on whether patients

Avoidable hospital deaths occur less frequently than estimated by the national monitoring tool, but much more frequently than reported through mandatory reporting systems. Regular reviews of an unselected sample of hospital deaths are likely to provide a better estimate of the proportion of avoidable deaths than the current methods.

Self-reported CVD was independently associated with increased occurrence of lung cancer in former and current smokers. CVD may be a novel risk factor for lung cancer screening.

ICS use is not associated with a reduced risk of lung cancer in our study population.

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After an initial run-in period with declining results, the overall diagnostic yield of EBUS-TBNA increased and reached acceptable levels. These results underline the importance of continuously evaluation of our own results when new methods are implemented in clinical practice.