title: Diabetes mellitus, fasting glucose, and risk of cause-specific death.
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.).
authors.affiliation: University of Cambridge, Cambridge, United Kingdom.
authors.forename: Sreenivasa
authors.initials: S
authors.lastname: Rao Kondapally Seshasai
authors.affiliation: University of Cambridge, Cambridge, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kaptoge
authors.affiliation: University of Cambridge, Cambridge, United Kingdom.
authors.forename: Alexander
authors.initials: A
authors.lastname: Thompson
authors.affiliation: University of Cambridge, Cambridge, United Kingdom.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Di Angelantonio
authors.affiliation: University of Cambridge, Cambridge, United Kingdom.
authors.forename: Pei
authors.initials: P
authors.lastname: Gao
authors.affiliation: University of Cambridge, Cambridge, United Kingdom.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Sarwar
authors.affiliation: St. George's University of London, London.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Whincup
authors.affiliation: Harvard University, Boston.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.affiliation: Centers for Disease Control and Prevention, Atlanta.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Gillum
authors.affiliation: Ullevål University Hospital, Oslo.
authors.forename: Ingar
authors.initials: I
authors.lastname: Holme
authors.affiliation: University of Tromsø, Tromsø, Norway.
authors.forename: Inger
authors.initials: I
authors.lastname: Njølstad
authors.affiliation: London School of Hygiene and Tropical Medicine, London.
authors.forename: Astrid
authors.initials: A
authors.lastname: Fletcher
authors.affiliation: Lund University, Lund, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Nilsson
authors.affiliation: University of Oxford, Oxford, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lewington
authors.affiliation: University of Oxford, Oxford, United Kingdom.
authors.forename: Rory
authors.initials: R
authors.lastname: Collins
authors.affiliation: Icelandic Heart Association and the University of Iceland, Reykjavik.
authors.forename: Vilmundur
authors.initials: V
authors.lastname: Gudnason
authors.affiliation: Medical Research Council Biostatistics Unit, Cambridge, United Kingdom.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Thompson
authors.affiliation: University of Glasgow, Glasgow, United Kingdom.
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.affiliation: Johns Hopkins University, Baltimore.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.affiliation: Harvard University, Boston.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.affiliation: University of Cambridge, Cambridge, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Danesh
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000401:mortality; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D012306:Risk; D016019:Survival Analysis
chemical_list: D001786:Blood Glucose