Diabetes Mellitus, Fasting Glucose, and Risk of Cause-Specific Death
Open accessAbstract
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.).
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Prediabetes is linked with increased risks of major manifestations of vascular disease, but it remains unclear whether the elevated disease risks depend on development of clinical diabetes.
“Prediabetes is linked with increased risks of major manifestations of vascular disease, but it remains unclear whether the elevated disease risks depend on development of clinical diabetes.84,85”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [85]
Recent individual-level evidence from prospective studies suggests that fasting hyperglycaemia, postload glucose, and A1c are all robust predictors of vascular mortality, and multivariable adjusted analyses indicate these associations are independent of vascular risk factors such as obesity, blood pressure, triglyceride and lipoproteins.
“A recent individual-level evidence from prospective studies suggests that fasting hyperglycaemia (figure 3), postload glucose, and A1c are all robust predictors of vascular mortality86,88,89 and, according to multivariable adjusted analyses, these associations are independent of vascular risk factors, such as obesity, blood pressure, triglyceride and lipoproteins.84,85,87”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [85]
A 50-year-old with T2DM died, on average, 6 years earlier than an individual without T2DM, with about 40% of the difference in survival attributable to excess non-vascular deaths.
“The study found that a 50-year-old with T2DM died, on average, 6 years earlier than an individual without T2DM, with about 40% of the difference in survival attributable to excess non-vascular deaths.95”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [95]
The Emerging Risk Factors Collaboration, including 820,900 people, demonstrates that T2DM is independently associated with increased risk of death from several cancers, renal and liver disease, pneumonia and other infectious diseases, mental and nervous system disorders, non-hepatic digestive diseases, external causes, and chronic obstructive pulmonary disease.
“Aside from CV death, results from the Emerging Risk Factors Collaboration, including 820 900 people, demonstrate that T2DM is independently associated with increased risk of death from several cancers (i.e.liver, pancreas, ovary, colorectum, lung, bladder, and breast), renal and liver disease, pneumonia and other infectious diseases, mental and nervous system disorders, non-hepatic digestive dis”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [95]
The longer life expectancy projections are consistent with downward secular trends in cardiovascular disease and improvements in mortality and are in line with previously reported estimates of the reduction in life expectancy due to diabetes.
“These are consistent with downward secular trends in cardiovascular disease and improvements in mortality and are in line with previously reported estimates of the reduction in life expectancy due to diabetes [23].”
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- Authors
- The Emerging Risk Factors Collaboration
- Affiliations
- University of Cambridge (GB)
- Corresponding author
- The Emerging Risk Factors Collaboration
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2011-03-03
- Volume
- 364
- Issue
- 9
- Pages
- 829-841
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC4109980
- OpenAlex
- W2126919962
- Semantic Scholar
- a89247dcde559e5839cef19b130059e2ad9abc75
- Cited by
- 2,726
- References
- 40
- Citations by year
- 2026: 102 · 2025: 138 · 2024: 186 · 2023: 151 · 2022: 200 · 2021: 225 · 2020: 218 · 2019: 182 · 2018: 190 · 2017: 203 · 2016: 190 · 2015: 196 · 2014: 193 · 2013: 145 · 2012: 147
- FWCI
- 141.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- PubMed Central (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Socio-Environmental Systems Modeling (submittedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Site cant be reached (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- OPUS (Augsburg University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Funders
- British Heart Foundation (RG/08/013/25942, RG/08/014, PG/09/002/26056, RG/07/008/23674, RG/08/014/24067)
- National Institutes of Health (n01hc085082-026, n01hc085081-021, n01hc085079-024, n01hc085083-027, n01hc085080-026, n01hc085086-022, UL1TR000062, n01hc55222-0-0-0)
- Economic and Social Research Council (ES/G007438/1)
- National Institute on Aging (R01AG023629)
- National Heart, Lung, and Blood Institute (N01 HC085086, N01 HC085079, N01 HC085083, N01 HC085080, HHSN 268200800007C, N01HC085082, U01HL080295, N01 HC055222, N01 HC085081)
- National Center for Research Resources (UL1RR025014)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetes mellitus, fasting blood glucose, hyperglycemia, cause-specific mortality, cancer mortality, vascular death, premature mortality, liver cancer, pancreatic cancer, ovarian cancer, colorectal cancer, lung cancer, breast cancer, renal disease mortality, infectious disease mortality, intentional self-harm, chronic obstructive pulmonary disease, mortality risk factors
- MeSH terms
- Blood Glucose, Cause of Death, Diabetes Mellitus, Female, Humans, Hyperglycemia, Life Expectancy, Male, Middle Aged, Risk, Survival Analysis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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