title: Increased cancer mortality in diabetic people treated with insulin: a register-based follow-up study.
abstract: BACKGROUND
  The national 10-year Development Programme for the Prevention and Care of Diabetes (DEHKO) was launched in Finland in 2000. The program focused on improving early diagnosis of type 2 diabetes and preventing diabetes-related complications. The FinDM database was established for epidemiological monitoring of diabetes and its complications. This study monitors mortality trends among people with diabetes during the DEHKO programme.
  
  
  METHODS
  A database obtained from a compilation of several administrative national health registers was used to study mortality in people with diabetes in 1998-2007. Relative excess mortality between people with and without diabetes was analyzed using Poisson regression models.
  
  
  RESULTS
  The number of diabetic people in Finland increased by 66% from 1997 reaching 284 832 in 2007. Like among non-diabetic people, all-cause mortality decreased in people with diabetes. Overall excess mortality remained high in people with diabetes; in 2003-2007 RRs in the non-insulin treated was 1.82 for men and 1.95 for women and in the insulin treated 3.45 and 4.29, and excess coronary heart disease mortality in the insulin treated: RR was 4.71 in men and 7.80 in women. A striking result was mortality from neoplasms; an increase in mortality emerged in almost every age group of insulin treated women.
  
  
  CONCLUSIONS
  Compared to non-diabetic people our monitoring showed declining excess mortality in non-insulin treated diabetic people mainly due to a decrease in mortality from cardiovascular diseases. For insulin treated, relative overall excess mortality remained unchanged and mortality from neoplasms increased among women.
authors.affiliation: National Institute for Health and Welfare, (THL), Service System Department, PO Box 30, FI-00271 Helsinki, Finland. erja.forssas@thl.fi
authors.forename: Erja
authors.initials: E
authors.lastname: Forssas
authors.forename: Reijo
authors.initials: R
authors.lastname: Sund
authors.forename: Kristiina
authors.initials: K
authors.lastname: Manderbacka
authors.forename: Martti
authors.initials: M
authors.lastname: Arffman
authors.forename: Pirjo
authors.initials: P
authors.lastname: Ilanne-Parikka
authors.forename: Ilmo
authors.initials: I
authors.lastname: Keskimäki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D003324:Coronary Artery Disease / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D016012:Poisson Distribution; D017678:Sex Distribution
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin