Aims/hypothesis Current evidence suggests that type 2 diabetes may have a greater impact on those with earlier diagnosis (longer duration of disease), but data are limited. We examined the effect of age at diagnosis of type 2 diabetes on the risk of all-cause and cause-specific mortality over 15 years. Methods The data of 743,709 Australians with type 2 diabetes who were registered on the National Diabetes Services Scheme (NDSS) between 1997 and 2011 were examined. Mortality data were derived by linking the NDSS to the National Death Index. All-cause mortality and mortality due to cardiovascular disease (CVD), cancer and all other causes were identified. Poisson regression was used to model mortality rates by sex, current age, age at diagnosis, diabetes duration and calendar time.Results The median age at registration on the NDSS was 60.2 years (interquartile range [IQR] 50.9-69.5) and the median followup was 7.2 years (IQR 3.4-11.3). The median age at diagnosis was 58.6 years (IQR 49.4-67.9). A total of 115,363 deaths occurred during 7.20 million person-years of follow-up. During the first 1.8 years after diabetes diagnosis, rates of all-cause and cancer mortality declined and CVD mortality was constant. All mortality rates increased exponentially with age. An earlier diagnosis of type 2 diabetes (longer duration of disease) was associated with a higher risk of all-cause mortality, primarily driven by CVD mortality. A 10 year earlier diagnosis (equivalent to 10 years' longer duration of diabetes) was associated with a 1.2-1.3 times increased risk of all-cause mortality and about 1.6 times increased risk of CVD mortality. The effects were similar in men and women. For mortality due to cancer (all cancers and colorectal and lung cancers), we found that earlier diagnosis of type 2 diabetes was associated with lower mortality compared with diagnosis at an older age. Conclusions/interpretation Our findings suggest that younger-onset type 2 diabetes increases mortality risk, and that this is mainly through earlier CVD mortality. Efforts to delay the onset of type 2 diabetes might, therefore, reduce mortality. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00125-018-4544-z) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Data from 1997 to 2010 showed that Australian type 1 diabetic patients had an estimated loss in life expectancy at birth of 12.2 years compared with the general population.

Abstract.Increasing evidence has shown that cancer stem cells or tumor initiating cells are the 'root cause' of malignant cancers. However, the exact origin of cancer stem cells still remains obscure in thyroid research. EMT has been implicated in the initiation and conversion of early-stage tumors into invasive malignancies and is associated with the stemness of cancer cells. Based on these facts, a new hypothesis was suggested that EMT induces cancer stem cell generation and tumor progression in human thyroid cancer cells in vitro. In the present study, FTC133 cells identified as EMT-negative cells were used for EMT induction by HIF-1α transfection. Overexpression of HIF-1α induced FTC133 cells to undergo EMT, downregulated the epithelial markers E-cadherin, upregulated the mesenchymal marker vimentin, and associated with highly invasive and metastatic properties. Most importantly, the induction of EMT promoted the stem-like side population cell proportion in the FTC133 cells. These results indicate that EMT induction promotes CSC traits and cell proportions in the thyroid cancer cells, which implies that EMT could induce cancer stem cell generation and tumor progression in thyroid cancers. Further understanding of the role of EMT and cancer stem cells in cancer progression may reveal new targets for the prevention or therapy of thyroid cancers. IntroductionAnaplastic thyroid carcinoma is an aggressive malignancy characterized by an extensive local invasion, early systemic dissemination and marked resistance to chemo-and radiotherapy, and always has a poor prognosis with a mean survival of only few months (1). Current systemic therapy fails to eradicate this cancer or even to stop tumor progress. It has been hypothesized that this may be explained by the failure of current drugs to effectively target cancer stem-like cells (CSCs) (2,3). To date, CSCs have been reported in various solid tumors and in cancer cell lines (4-9). However, until recently, there are only very few studies on adult thyroid stem/progenitor cells and thyroid CSCs (10-12). We and others have recently described and characterized thyroid cancer stem cells as a side population (13-17) that may play a critical role in the progression and recurrence of cancer and its subsequent metastasis (18).Epithelial to mesenchymal transition (EMT) is a vital process for morphogenesis during embryonic development, but it has also been implicated in the conversion of early stage tumors into invasive malignancies (19). More recent studies have further demonstrated that EMT plays a critical role not only in tumor metastasis but also in tumor recurrence that is believed to be tightly linked with the biology of cancer stem-like cells or cancer-initiating cells (20-23). The relationship between EMT and CSCs has been observed, with the evidence suggesting that EMT cells acquire stem cell-like traits and that CSCs exhibit a mesenchymal-like appearance in immortalized non-tumorigenic mammary epithelial cells and breast cancers (22). In thyroid cancer, it was found i...