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Abstract: Objective: To examine whether trends in death rate from diabetes according to multiple-cause-of-death (MCOD) data differed from those according to underlying-cause-of-death (UCOD) data in Taiwan and the United States. Study Design and Setting: We used multiple cause mortality files for the years 1987, 1992, 1997, 2002, and 2007 to calculate the age-adjusted death rates from diabetes according to MCOD and UCOD and the ratio between diabetes mortality according to UCOD and that according to MCOD (U/M ratio) in Taiwan and the United States. Results: In Taiwan, diabetes mortality according to MCOD increased persistently from 1987 to 2007, but no prominent changes were found according to UCOD in men. For women, the death rates according to MCOD did not change significantly between 1987 and 2007 but decreased drastically from 1992 to 2007 according to UCOD. In the United States, the patterns of change in diabetes mortality according to MCOD were similar to those according to UCOD in both sexes. The U/M ratio of diabetes mortality declined persistently between 1987 and 2007 in Taiwan, but no prominent change was found in the United States. Conclusion: Trends in death rate from diabetes according to MCOD differed from that according to UCOD in Taiwan but not in the United States. To properly interpret cause-specific mortality trends, it is important to provide both MCOD and UCOD data. [Copyright &y& Elsevier]