title: Increased cancer mortality in type 2 diabetes (ZODIAC-3).
abstract: BACKGROUND
  It is unclear whether there is a relationship between type two diabetes and cancer mortality. It also is unclear whether obesity and body mass index (BMI) are associated with cancer in type 2 diabetes patients.
  
  
  METHODS
  In 1998, 1,145 patients with type two diabetes mellitus were enrolled in the Zwolle Outpatient Diabetes project Intergrating Available Care (ZODIAC) study. In this project, general practitioners (GPs) were assisted by hospital-based diabetes specialist nurses. Vital status was assessed in September 2004. The cancer mortality rate was evaluated using standardized mortality ratio (SMR) and its association with BMI (kg/m2) and obesity (>30 kg/m2) with the Cox proportional hazard ratio.
  
  
  RESULTS
  The median follow-up time was 5.8 years. A total of 335 patients had died, of whom 70 died from malignancy. The SMR for cancer mortality was 1.38 (95% CI 1.07-1.75). BMI and obesity were not associated with cancer death.
  
  
  CONCLUSIONS
  An increased cancer mortality rate was found in type two diabetes mellitus patients but there was no significant association between BMI or obesity and cancer mortality.
authors.affiliation: Diabetes Centre, Isala Clinics, Zwolle, The Netherlands. g.w.d.landman@isala.nl
authors.forename: G W D
authors.initials: GW
authors.lastname: Landman
authors.forename: L J
authors.initials: LJ
authors.lastname: Ubink-Veltmaat
authors.forename: N
authors.initials: N
authors.lastname: Kleefstra
authors.forename: B J
authors.initials: BJ
authors.lastname: Kollen
authors.forename: H J G
authors.initials: HJ
authors.lastname: Bilo
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000401:mortality*; D009426:Netherlands / Q000453:epidemiology