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Diabetes mellitus, fasting glucose, and risk of cause-specific death: The Emerging Risk Factors Collaboration
Seshasai, Sreenivasa Rao Kondapally Kaptoge, Stephen Thompson, Alexander Di Angelantonio, Emanuele Gao, Pei Sarwar, Nadeem Whincup, Peter H. Mukamal, Kenneth J. Gillum, Richard F. Holme, Ingar
Seshasai, Sreenivasa Rao Kondapally
Kaptoge, Stephen
Thompson, Alexander
Di Angelantonio, Emanuele
Gao, Pei
Sarwar, Nadeem
Whincup, Peter H.
Mukamal, Kenneth J.
Gillum, Richard F.
Holme, Ingar
Author
Seshasai, Sreenivasa Rao Kondapally
Kaptoge, Stephen
Thompson, Alexander
Di Angelantonio, Emanuele
Gao, Pei
Sarwar, Nadeem
Whincup, Peter H.
Mukamal, Kenneth J.
Gillum, Richard F.
Holme, Ingar
Njølstad, Inger
Fletcher, Astrid
Nilsson, Peter
Lewington, Sarah
Collins, Rory
Gudnason, Vilmundur
Thompson, Simon G.
Sattar, Naveed
Selvin, Elizabeth
Hu, Frank B.
Danesh, John
Kaptoge, Stephen
Thompson, Alexander
Di Angelantonio, Emanuele
Gao, Pei
Sarwar, Nadeem
Whincup, Peter H.
Mukamal, Kenneth J.
Gillum, Richard F.
Holme, Ingar
Njølstad, Inger
Fletcher, Astrid
Nilsson, Peter
Lewington, Sarah
Collins, Rory
Gudnason, Vilmundur
Thompson, Simon G.
Sattar, Naveed
Selvin, Elizabeth
Hu, Frank B.
Danesh, John
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.)
Keywords
Date
2011
Type
Journal article
Journal
New England Journal of Medicine
Book
Volume
364
Issue
9
Page Range
829-841
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled
Notes
Listed authors are members of the writing committee for The Emerging Risk Factors Collaboration. The study investigators are listed in the Supplementary Appendix, available at [https://doi.org/10.1056/NEJMoa1008862] https://doi.org/10.1056/NEJMoa1008862.