Cancer has overtaken cardiovascular disease as the commonest cause of death in Scottish type 2 diabetes patients: A population‐based study (The Ayrshire Diabetes Follow‐up Cohort study)

Abstract

Aims/IntroductionThe increased mortality risk associated with diabetes is well established. The aim of the present study was to determine the causes of death of people with type 2 diabetes in Ayrshire and Arran, Scotland, between 2009 and 2014, and compare them with the national mortality rates.Materials and MethodsThe primary causes of death were collated. The causes of death were clustered into nine categories: heart disease, stroke, infection, renal failure, respiratory disorders, cancer, mental health, decompensated diabetes and other. The total rates were compared with national rates using the standardized mortality ratio (SMR), and then individually with heart disease, cerebrovascular disease and cancer.ResultsThere were 2116 deaths with the SMR, and 145 of those were caused by type 2 diabetes (n = 16,643; 95% confidence interval 139–152; P < 0.01). The SMR was >100 in all age bands, particularly in the younger age bands (P < 0.01). The SMR was consistently higher for women (P < 0.01). The SMR for heart disease was significantly >100 for both sexes in all age bands <65 years (P < 0.05). There was no difference in mortality causes related to the duration of diabetes. The most common cause of death was cancer (27.8%), followed by heart disease (24.1%). The SMR for cancer deaths was significantly elevated in women (120, 95% CI 104–137; P < 0.05).ConclusionsThis study confirmed increased mortality risk in type 2 diabetes patients, and suggests that where cardiovascular risk factors are being treated aggressively, cancer takes on a greater importance in the cause of death. Should greater consideration now be given for cancer as a complication of diabetes?

The right place for metformin today

“…T2DM appears to be an independent risk factor for pancreatic, endometrial, liver, colorectal, bladder and breast cancer [44]. Possible mechanisms linking diabetes with cancer include hyperglycemia and hyperinsulinemia (endogenous or exogenous), plus alterations of the insulin-like growth factor system, chronic subclinical inflammation, abnormalities in sex hormone metabolism, adipokines and possibly antidiabetes medication used in the management of T2DM [45].…”

“…A recently published population-based study [45] demonstrated that cancer has overtaken CVD as the commonest cause of death in T2DM patients in Scotland. Within the study period (2009-2014), 12.7% of people with T2DM died, the most common cause of death was cancer (27.8%), followed by heart disease (24.1%).…”

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“…Studies (Xu et al 2017;Yu et al 2018) have shown that an increase in insulin resistance and the incidence of hyperlipidemia has led to the global epidemic of T2DM. At present, the clinical treatment of T2DM centers more on good quality of life and extension of the lifespan of patients (Collier et al 2020). Drug therapy, diet, and exercise interventions are presently the mainstream treatments for T2DM.…”

Risk-based diabetes screening in a Hungarian general practice: comparison of laboratory methods and diagnostic criteria

“…Pre-diabetes may be present approximately 5 to 15 years before diabetes is diagnosed and certain target organ impairmentsprimarily macrovascular complicationscan develop during this period (Ramlo-Halsted and Edelman, 1999). Moreover, the imbalance in carbohydrate metabolism creates favourable conditions for cancer development (Giovannucci et al, 2010;Nakamura et al, 2017;Collier et al, 2019). Epidemiological research has also confirmed that socio-economic status is a major factor in the development of pre-diabetes and T2DM (Vokó et al, 2009;Masseria et al, 2010;Kósa et al, 2011).…”