Although the data from Meacham et al1 and ours differ in several respects, our results agree with the finding of an increased risk of DM following high-dose abdominal irradiation. In the study by Meacham et al,1 the patients were irradiated during childhood, whereas the patients with peptic ulcers were irradiated much later in life, mostly at ages 30 years or older. The abdominal dose received by the patients in the study by Meacham et al1 is assumed to be 20 to 30 Gy, whereas in our study, the increased risk of DM was found in those receiving 8 to 31 Gy to the pancreas (mean, 14.6 Gy). Doses to distant organs, such as the brain, were negligible. The association of DM following total body irradiation in children and adults has been documented,4,5 but less well known is the occurrence of DM following abdominal, or more specifically, pancreatic irradiation. Our previous studies3 showed radiation-related risks of pancreatic and gastric cancers in the patients with peptic ulcers. The effect of dying from these fatal cancers, if any, would have been to reduce the number of persons dying from DM in the high-radiation dose group. A small case series reported that DM occurred 6 to 20 years later in 4 of 5 adults who received abdominal radiation for either Hodgkin lymphoma or testis cancer.6 In the study by Meacham et al,1 DM was considered mostly type 2 based on medication history. As we ascertained DM from death certificate information, unresolved questions in our study relate to the type of DM involved or response to insulin treatment, which reflects the degree of pancreatic cell damage from radiation at high-dose levels.