Cancer, not cardiovascular disease, is the leading cause of death in type 2 diabetes, a new study has found. This breaks the conventional wisdom that the cause of death in diabetes is a cardiovascular disease complication, suggesting the need for a multidisciplinary approach.
The results of a study on the mortality rate of patients with type 2 diabetes, including researchers at the Leicester Diabetes Research Center in England, were published in the international journal Diabetologia on the 24th (doi.org/10.1007/s00125-022-05854-8).
Type 2 diabetes is associated with a high risk of multiple vascular complications, including myocardial infarction, stroke, peripheral arterial disease, and kidney disease, leading to premature death.
Prior studies have shown that major cardiovascular complications and mortality in diabetic patients in some high-income countries have declined over the past 20 years, with a higher contribution from other diseases such as cancer, suggesting a changing landscape for diabetic mortality.
Accumulating epidemiological evidence from prior studies has shown that the risk of occurrence and death is indeed higher for some types of cancer, along with prolonged exposure to the effects of hyperglycemia, hyperinsulinemia, insulin resistance and chronic inflammation.
The research team newly diagnosed type 2 diabetes between January 1, 1998 and November 30, 2018 in the Clinical Practice Research Datalink to determine if there was a causal relationship between type 2 diabetes and pancreatic cancer, liver cancer, and endometrial cancer. The average follow-up was 8.4 years for subjects aged 35 years or older.
All-cause mortality at any age between 1998 and 2018 among a total of 137,804 subjects, assessing trends in all-cause, all-cancer, and specific-cancer mortality by age, gender, ethnicity, socioeconomic status, obesity, and smoking status this decreased
Cancer mortality decreased for 55 and 65 year olds (-1.4% and -0.2% respectively), but increased for 75 and 85 year olds (1.2% and 1.6%).
In contrast to a decrease in all-cause mortality across all age groups, the burden of colorectal, pancreatic, liver and endometrial cancers increased in older adults with type 2 diabetes.
Mortality from all cancers was 18% higher in patients with type 2 diabetes than in the general population.
Mortality from breast cancer was 9% higher and mortality from endometrial cancer was 2.08 times higher in women with type 2 diabetes than in women in the general population.
“Death rates from all causes decreased in people with type 2 diabetes at all ages, while death rates from all cancers decreased in those younger than 65 years of age, but increased in the older age group,” the researchers said. This suggests that the burden of cancer is increasing, especially among the elderly.”