title: Diabetes, prediabetes and cancer mortality.
abstract: OBJECTIVE
  We aimed to investigate the risk of cancer mortality in relation to the glucose tolerance status classified according to the 2 h OGTT.
  
  
  METHODS
  Data from 17 European population-based or occupational cohorts involved in the DECODE study comprising 26,460 men and 18,195 women aged 25-90 years were collaboratively analysed. The cohorts were recruited between 1966 and 2004 and followed for 5.9 to 36.8 years. Cox proportional hazards analysis with adjustment for cohort, age, BMI, total cholesterol, blood pressure and smoking status was used to estimate HRs for cancer mortality.
  
  
  RESULTS
  Compared with people in the normal glucose category, multivariable adjusted HRs (95% CI) for cancer mortality were 1.13 (1.00, 1.28), 1.27 (1.02, 1.57) and 1.71 (1.35, 2.17) in men with prediabetes, previously undiagnosed diabetes and known diabetes, respectively; in women they were 1.11 (0.94, 1.30), 1.31 (1.00, 1.70) and 1.43 (1.01, 2.02), respectively. Significant increases in deaths from cancer of the stomach, colon-rectum and liver in men with prediabetes and diabetes, and deaths from cancers of the liver and pancreas in women with diabetes were also observed. In individuals without known diabetes, the HR (95% CI) for cancer mortality corresponding to a one standard deviation increase in fasting plasma glucose was 1.06 (1.02, 1.09) and in 2 h plasma glucose was 1.07 (1.03, 1.11).
  
  
  CONCLUSIONS
  Diabetes and prediabetes were associated with an increased risk of cancer death, particularly death from liver cancer. Mortality from all cancers rose linearly with increasing glucose concentrations.
authors.affiliation: Department of Public Health, University of Helsinki, PL41, Mannerheimintie 172, Helsinki, Finland.
authors.forename: X H
authors.initials: XH
authors.lastname: Zhou
authors.forename: Q
authors.initials: Q
authors.lastname: Qiao
authors.forename: B
authors.initials: B
authors.lastname: Zethelius
authors.forename: K
authors.initials: K
authors.lastname: Pyörälä
authors.forename: S
authors.initials: S
authors.lastname: Söderberg
authors.forename: A
authors.initials: A
authors.lastname: Pajak
authors.forename: C D A
authors.initials: CD
authors.lastname: Stehouwer
authors.forename: R J
authors.initials: RJ
authors.lastname: Heine
authors.forename: P
authors.initials: P
authors.lastname: Jousilahti
authors.forename: G
authors.initials: G
authors.lastname: Ruotolo
authors.forename: P M
authors.initials: PM
authors.lastname: Nilsson
authors.forename: G
authors.initials: G
authors.lastname: Calori
authors.forename: J
authors.initials: J
authors.lastname: Tuomilehto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality*; D011236:Prediabetic State / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors