(19-03-11) Diabetes mellitus, fasting glucose, and risk of cause-specific death.

Emerging Risk Factors Collaboration, Seshasai SR, Kaptoge S, Thompson A, Di
Angelantonio E, Gao P, Sarwar N, Whincup PH, Mukamal KJ, Gillum RF, Holme I,
Nj?lstad I, Fletcher A, Nilsson P, Lewington S, Collins R, Gudnason V, Thompson
SG, Sattar N, Selvin E, Hu FB, Danesh J.

Collaborators (284)
Abstract
BACKGROUND: The extent to which diabetes mellitus or hyperglycemia is related
to risk of death from cancer or other nonvascular conditions is uncertain.

METHODS: We calculated hazard ratios for cause-specific death, according to
baseline diabetes status or fasting glucose level, from individual-participant
data on 123,205 deaths among 820,900 people in 97 prospective studies.

RESULTS: After adjustment for age, sex, smoking status, and body-mass index,
hazard ratios among persons with diabetes as compared with persons without
diabetes were as follows: 1.80 (95% confidence interval [CI], 1.71 to 1.90) for
death from any cause, 1.25 (95% CI, 1.19 to 1.31) for death from cancer, 2.32
(95% CI, 2.11 to 2.56) for death from vascular causes, and 1.73 (95% CI, 1.62
to 1.85) for death from other causes. Diabetes (vs. no diabetes) was moderately
associated with death from cancers of the liver, pancreas, ovary, colorectum,
lung, bladder, and breast. Aside from cancer and vascular disease, diabetes
(vs. no diabetes) was also associated with death from renal disease, liver
disease, pneumonia and other infectious diseases, mental disorders, nonhepatic
digestive diseases, external causes, intentional self-harm, nervous-system
disorders, and chronic obstructive pulmonary disease. Hazard ratios were
appreciably reduced after further adjustment for glycemia measures, but not
after adjustment for systolic blood pressure, lipid levels, inflammation or
renal markers. Fasting glucose levels exceeding 100 mg per deciliter (5.6 mmol
per liter), but not levels of 70 to 100 mg per deciliter (3.9 to 5.6 mmol per
liter), were associated with death. A 50-year-old with diabetes died, on
average, 6 years earlier than a counterpart without diabetes, with about 40% of
the difference in survival attributable to excess nonvascular deaths.

CONCLUSIONS: In addition to vascular disease, diabetes is associated with
substantial premature death from several cancers, infectious diseases, external
causes, intentional self-harm, and degenerative disorders, independent of
several major risk factors. (Funded by the British Heart Foundation and
others.).

Source: N Engl J Med. 2011 Mar 3;364(9):829-41.

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