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.