title: Diabetes mellitus increases the risk of bladder cancer: an updated meta-analysis.
abstract: OBJECTIVE
  Studies have indicated that diabetes mellitus (DM) is a risk factor for bladder cancer; however, not all evidence supports this conclusion. The aim of this meta-analysis was to collate and evaluate all primary observational studies investigating the risk of bladder cancer associated with DM.
  
  
  METHODS
  The PubMed and Google Scholar databases were searched to identify studies that estimated the association of DM and bladder cancer. Summary effect estimates were derived using a random-effects meta-analysis model.
  
  
  RESULTS
  A total of 23 studies (8 case-control studies, 15 cohort studies) including 643,683 DM and 4,819,656 non-DM cases were identified. Analysis of all studies showed that DM was associated with an increased risk of bladder cancer compared with non-DM overall (OR=1.68, 95% CI 1.32-2.13). Analysis of subgroups demonstrated this to be the case in both case-control studies (OR=1.59, 95% CI 1.28-1.97, I2=58%) and cohort studies (RR=1.70, 95% CI 1.23-2.33, I2=96%). There was no gender difference in DM-associated bladder cancer risk. Bladder cancer risk was increased in Asia and the North America region, but not in Europe. Furthermore, DM-associated bladder cancer risk was obviously higher in Asia than North America and Europe or in those with Caucasian ethnicity. With extension of follow-up time, the bladder cancer risk was not increased for the patients with DM.
  
  
  CONCLUSIONS
  This meta-analysis provided further evidence supporting the DM association with a significantly higher risk of bladder cancer obtained from observational studies.
authors.affiliation: Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Tianjin, China.
authors.forename: Xiao-Qing
authors.initials: XQ
authors.lastname: Yang
authors.forename: Chen
authors.initials: C
authors.lastname: Xu
authors.forename: Yan
authors.initials: Y
authors.lastname: Sun
authors.forename: Rui-Fa
authors.initials: RF
authors.lastname: Han
mesh_terms: D016022:Case-Control Studies; D048909:Diabetes Complications / Q000209:etiology*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D006801:Humans; D011379:Prognosis; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000209:etiology*