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N Engl J Med. 2011 Mar 3;364(9):829-41. doi: 10.1056/NEJMoa1008862.

Diabetes mellitus, fasting glucose, and risk of cause-specific death.

Collaborators (284)

Tipping RW, Ford CE, Simpson LM, Folsom AR, Chambless LE, Selvin E, Wagenknecht LE, Panagiotakos DB, Pitsavos C, Chrysohoou C, Stefanadis C, Knuiman M, Goldbourt U, Benderly M, Tanne D, Whincup PH, Wannamethee SG, Morris RW, Kiechl S, Willeit J, Oberhollenzer F, Mayr A, Wald N, Ebrahim S, Lawlor DA, Yarnell JW, Gallacher J, Casiglia E, Tikhonoff V, Nietert PJ, Sutherland SE, Bachman DL, de Boer IH, Kizer JR, Mukamal KJ, Tybjærg-Hansen A, Nordestgaard BG, Benn M, Frikke-Schmidt R, Giampaoli S, Palmieri L, Panico S, Vanuzzo D, Pilotto L, Gómez de la Cámara A, Rubio MA, Simons L, McCallum J, Friedlander Y, Fowkes FG, Lee AJ, Taylor J, Guralnik JM, Phillips CL, Wallace R, Guralnik JM, Phillips CL, Blazer DG, Guralnik JM, Phillips CL, Phillips CL, Guralnik JM, Khaw KT, Brenner H, Raum E, Müller H, Rothenbacher D, Jansson JH, Wennberg P, Nissinen A, Donfrancesco C, Giampaoli S, Salomaa V, Harald K, Jousilahti P, Vartiainen E, Woodward M, D'Agostino RB Sr, Vasan RS, Fox CS, Pencina MJ, Bladbjerg E, Jørgensen T, Møller L, Jespersen J, Dankner R, Chetrit A, Lubin F, Wilhelmsen L, Eriksson H, Svärdsudd K, Welin L, Rosengren A, Wilhelmsen L, Lappas G, Eriksson H, Björkelund C, Lissner L, Bengtsson C, Cremer P, Nagel D, Strandberg TE, Salomaa V, Tilvis RS, Miettinen TA, Tilvis RS, Strandberg TE, Kiyohara Y, Arima H, Doi Y, Ninomiya T, Rodriguez B, Dekker JM, Nijpels G, Stehouwer CD, Hu FB, Sun Q, Rimm EB, Willett WC, Iso H, Kitamura A, Yamagishi K, Noda H, Goldbourt U, Nyyssönen K, Tuomainen TP, Salonen JT, Deeg D, Poppelaars JL, Meade TW, Cooper JA, Hedblad B, Nilsson P, Engström G, Verschuren WM, Blokstra A, Cushman M, Folsom AR, Psaty BM, Shea S, Döring A, Koenig W, Meisinger C, Verschuren WM, Blokstra A, Bueno-de-Mesquita HB, Wilhelmsen L, Rosengren A, Lappas G, Fletcher A, Hewitt J, Nitsch D, Kuller LH, Grandits G, Selmer R, Tverdal A, Nystad W, Gillum RF, Mussolino M, Hu FB, Sun Q, Manson JE, Hankinson SE, Salomaa V, Harald K, Jousilahti P, Vartiainen E, Cooper JA, Bauer KA, Davidson KW, Kirkland S, Shaffer JA, Korin MR, Kitamura A, Iso H, Sato S, Holme I, Selmer R, Tverdal A, Nystad W, Ducimetiere P, Jouven X, Bakker SJ, Gansevoort RT, Hillege HL, Crespo CJ, Garcia-Palmieri M, Amouyel P, Arveiler D, Evans A, Ferrières J, Schulte H, Assmann G, Westendorp RG, Buckley BM, Packard CJ, Sattar N, Cantin B, Lamarche B, Després JP, Dagenais GR, Barrett-Connor E, Wingard DL, Bettencourt R, Gudnason V, Aspelund T, Sigurdsson G, Thorsson B, Trevisan M, Witteman J, Kardys I, Tiemeier H, Hofman A, Tunstall-Pedoe H, Tavendale R, Lowe GD, Woodward M, Howard BV, Zhang Y, Best L, Umans J, Ben-Shlomo Y, Davey-Smith G, Onat A, Hergenç G, Can G, Njølstad I, Mathiesen EB, Løchen ML, Wilsgaard T, Zethelius B, Risérus U, Berne C, Ingelsson E, Gaziano JM, Stampfer M, Ridker P, Gaziano JM, Ridker P, Ulmer H, Diem G, Concin H, Tosetto A, Rodeghiero F, Manson JE, Tinker L, Liu S, Howard BV, Marmot M, Clarke R, Collins R, Fletcher A, Brunner E, Shipley M, Ridker P, Buring J, Shepherd J, Cobbe SM, Ford I, Robertson M, Marín Ibañez A, Feskens EJ, Kromhout D, Walker M, Watson S, Alexander M, Di Angelantonio E, Collins R, Gao P, Gobin R, Haycock P, Kaptoge S, Seshasai SR, Lewington S, Pennells L, Sarwar N, Thompson A, Thompson SG, Walker M, Watson S, White IR, Wood AM, Wormser D, Danesh J.

Erratum in

  • N Engl J Med. 2011 Mar 31;364(13):1281.

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.).

Comment in

PMID:
21366474
[PubMed - indexed for MEDLINE]
PMCID:
PMC4109980
Free PMC Article

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