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

Study Questions:

What are the associations of baseline diabetes and fasting blood glucose level with the risk of cause-specific death?

Methods:

The investigators 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], 1.71-1.90) for death from any cause, 1.25 (95% CI, 1.19-1.31) for death from cancer, 2.32 (95% CI, 2.11-2.56) for death from vascular causes, and 1.73 (95% CI, 1.62-1.85) 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/dl (5.6 mmol/L), but not levels of 70-100 mg/dl (3.9-5.6 mmol/L), 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:

The authors concluded that diabetes is associated with substantial premature death from several cancers, infectious diseases, external causes, intentional self-harm, and degenerative disorders.

Perspective:

These data show that diabetes is associated with substantial premature mortality from several cancers, infectious diseases, external causes, intentional self-harm, and degenerative disorders, independent of several major risk factors. About 40% of the years of life lost from diabetes can be attributed to nonvascular conditions, including about 10% attributable to death from cancer. These findings highlight the need to better understand and prevent the multisystem consequences of diabetes.

Clinical Topics: Prevention, Diet

Keywords: Cause of Death, Nervous System Diseases, Mortality, Premature, Blood Glucose, Vascular Diseases, Risk Factors, Fasting, Diabetes Mellitus, Glucose


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