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

被引:2047
作者
Seshasai, Sreenivasa Rao Kondapally
Kaptoge, Stephen
Thompson, Alexander
Di Angelantonio, Emanuele
Gao, Pei
Sarwar, Nadeem
Whincup, Peter H. [1 ]
Mukamal, Kenneth J.
Gillum, Richard F. [2 ]
Holme, Ingar [3 ]
Njolstad, Inger [4 ]
Fletcher, Astrid [5 ]
Nilsson, Peter [6 ]
Lewington, Sarah [7 ]
Collins, Rory [7 ]
Gudnason, Vilmundur [8 ,9 ]
Thompson, Simon G. [10 ]
Sattar, Naveed [11 ]
Selvin, Elizabeth [12 ]
Hu, Frank B. [13 ]
Danesh, John
机构
[1] St Georges Univ London, London, England
[2] Ctr Dis Control & Prevent, Atlanta, GA USA
[3] Ullevaal Univ Hosp, Oslo, Norway
[4] Univ Tromso, Tromso, Norway
[5] Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England
[6] Lund Univ, Lund, Sweden
[7] Univ Oxford, F Med Sci, Oxford, England
[8] Univ Iceland, Reykjavik, Iceland
[9] Iceland Heart Assoc, Reykjavik, Iceland
[10] MRC, Biostat Unit, Cambridge CB2 2BW, England
[11] Univ Glasgow, Glasgow, Lanark, Scotland
[12] Johns Hopkins Univ, Baltimore, MD USA
[13] Harvard Univ, Boston, MA 02115 USA
基金
英国医学研究理事会;
关键词
CANCER-MORTALITY; ASSOCIATION; METAANALYSIS; INSULIN;
D O I
10.1056/NEJMoa1008862
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.)
引用
收藏
页码:829 / 841
页数:13
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