Diabetes Mellitus, Fasting Glucose, and Risk of Cause-Specific Death

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.)

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

“…Women had a higher risk of death due to index stroke/recurrent stroke 40.2% versus 33.3%; ns but a lower risk of death due to cancer 5% versus 9%. In patients with increased fasting blood glucose levels/diabetes mellitus, increased mortality rates have been reported (Emerging Risk Factors Collaboration, 2011; Eriksson & Olsson, 2001) as in the present trial where the differences existed mainly for index stroke. Men had a higher risk of death due to cardiosclerosis, heart failure, or arrhythmia versus women ( p  = .014), which could have partly depended on a higher frequency of several MIs.…”

Plasma levels of the proprotein convertase furin and incidence of diabetes and mortality

“…Because DM predicts premature mortality of virtually all causes 1, we tested in a next step if baseline plasma furin levels relate to death from any cause. Participants with elevated furin levels at baseline were observed to be at higher risk of death compared to individuals with lower furin levels.…”

“…Diabetes mellitus (DM) is associated with risk of premature mortality from vascular disease, several cancers and nonvascular causes not attributed to cancer, including digestive diseases, infectious diseases and neurological disorders, independently of major risk factors 1.…”

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

“…Whether this improvement in CHD as a result of risk factor control translates to a reduction in mortality after revascularization has not previously been reported and our observational study provides data from a large cohort suggesting this may be the case and provides stimulus for further research. In addition to macro‐ and microvascular disease, the Emerging Risk Factors Collaboration study reported diabetes to be associated with increased premature death from several cancers, infectious diseases, intentional self‐harm, and degenerative disorders, independent of major risk factors 14. This large cohort study defined baseline diabetes status on the basis of self‐report, medication use, fasting glucose level ≥126 mg/dL [7.0 mmol/L], or a combination of these but did not differentiate mortality on the basis of differences in management strategies.…”