Cancer incidence and mortality in 23 000 patients with type 1 diabetes in the UK : long‐term follow‐up

Type 2 diabetes is associated with raised risk of several cancers, but for type 1 diabetes risk data are fewer and inconsistent We assembled a cohort of 23 473 UK patients with insulin‐treated diabetes diagnosed at ages <30, almost all of whom will have had type 1 diabetes, and for comparison 5058 diagnosed at ages 30 to 49, of whom we estimate two‐thirds will have had type 2, and followed them for an average of 30 years for cancer incidence and mortality compared with general population rates. Patients aged <30 at diabetes diagnosis had significantly raised risks only for ovarian (standardised incidence ratio = 1.58; 95% confidence interval 1.16‐2.11; P < .01) and vulval (3.55; 1.94‐5.96; P < .001) cancers, with greatest risk when diabetes was diagnosed at ages 10‐14. Risks of cancer overall (0.89; 0.84‐0.95; P < .001) and sites including lung and larynx were significantly diminished. Patients diagnosed with diabetes at ages 30 to 49 had significantly raised risks of liver (1.76;1.08‐2.72) and kidney (1.46;1.03‐2.00) cancers, and reduced risk of cancer overall (0.89; 0.84‐0.95). The raised ovarian and vulval cancer risks in patients with type 1 diabetes, especially with diabetes diagnosed around pubertal ages, suggest possible susceptibility of these organs at puberty to metabolic disruption at diabetes onset. Reduced risk of cancer overall, particularly smoking and alcohol‐related sites, might reflect adoption of a healthy lifestyle

The prevalence of diabetic nephropathy : a study based on proteinuria and albuminuria in a defined diabetic population

During a surveillance programme, all the known diabetics (917) were identified from a study population of 90,660 representing all the patients registered with 40 general practitioners. A single observer reviewed 842 (92% ) of these diabetics. Proteinuria (0.3 g/l or more) was detected using Albustix in 57 cases (6.8%), but in 9 this was in association with an urinary tract infection. There was a significant relationship between the presence of retinopathy and proteinuria. Both systolic and diastolic blood pressure levels were significantly higher in diabetics with proteinuria than those without. Serum creatinine was greater than 150 umol/l in 29 (3.8%) of the 768 diabetics in whom it was measured. However, proteinuria was only found in 7 of the diabetics with impaired renal function. Urinary albumin was measured by a micro-ELISA technique on random urine samples and timed overnight urine collections. Laboratory reference ranges were determined for the daytime random albumin/creatinine ratio (RA/C) and the overnight albumin excretion rate (AER) using 114 non-diabetic controls. Age, systolic and diastolic blood pressure levels were significantly correlated with AER, but not RA/C, in the controls, although following a multiple regression analysis only systolic blood pressure remained significant. A raised RA/C was found in 38% (204 fo 532) of the diabetics and a raised AER in 30% (133 of 450) of the diabetics. AER was significantly correlated with blood glucose, HbAl, systolic blood pressure, diastolic blood pressure, body mass index, male sex, presence of retinopathy and current smoking habit. A stepwise multiple regression found only blood glucose, body mass index, current smoking habit and systolic blood pressure to be significant, and together accounted for 10.5% of the variation in AER. (D71794/87)</p