Quantifying the associations between diabetes mellitus, glycated haemoglobin and incidence of and mortality from cancer: analysis of longitudinal data from England and Scotland linked to Cancer Registry and mortality data

Background Studies which have sought to explore the associations between diabetes and cancer have produced heterogeneous results and there is a paucity of evidence related to glycated haemoglobin (HbA1c) and cancer risk. Methods Initial analyses utilised data from the Health Survey for England (HSE) and SHeS combined linked to mortality and Cancer Registry data (n=204,533, including 7,199 with diabetes) to explore the associations between diabetes, HbA1c and cancer incidence and mortality. Additional analyses used linked Whitehall I data (n= 19,019, including 237 with diabetes). Odds Ratios (ORs), Hazard Ratios and 95% Confidence Intervals (CI) were estimated adjusted for a range of confounding factors using logistic, multinomial and Cox regression. Results 18,310 deaths occurred within the HSE/SHeS follow-up period (4,997 from cancer). The adjusted OR for cancer among those with diabetes was 1.27, CI 1.12-1.43. Raised HbA1c was associated with an excess risk of dying/developing cancer; diabetes and HbA1c were associated with a number of site-specific cancers. When analyses were stratified by cardiovascular disease (CVD) baseline status, only those with diabetes who did not report CVD had a statistically significant excess in cancer mortality (adjusted OR: 1.27, 1.08-1.48). There were also sex differences in cancer incidence and mortality risk. 81% of Whitehall I participants died during follow-up (including 4,076 from cancer). These results did not replicate the initial analyses in finding no association between diabetes and cancer mortality -this is likely to relate to the age of the two cohorts and the differences in CVD mortality and incidence. Conclusion The association of diabetes and HbA1c with increased cancer incidence and mortality was not consistent across studies or population groups. Differences in risk by sex and CVD status suggest the need for health professionals to tailor services to take account of the individual circumstances of their diabetic patients

Impaired Glucose Metabolism among Those with and without Diagnosed Diabetes and Mortality: A Cohort Study Using Health Survey for England Data.

The extent that controlled diabetes impacts upon mortality, compared with uncontrolled diabetes, and how pre-diabetes alters mortality risk remain issues requiring clarification

Fruit and vegetable consumption and all-cause, cancer and CVD mortality : analysis of Health Survey for England data

Background Governments worldwide recommend daily consumption of fruit and vegetables. We examine whether this benefits health in the general population of England. Methods Cox regression was used to estimate HRs and 95% CI for an association between fruit and vegetable consumption and all-cause, cancer and cardiovascular mortality, adjusting for age, sex, social class, education, BMI, alcohol consumption and physical activity, in 65 226 participants aged 35+ years in the 2001–2008 Health Surveys for England, annual surveys of nationally representative random samples of the non-institutionalised population of England linked to mortality data (median follow-up: 7.7 years). Results Fruit and vegetable consumption was associated with decreased all-cause mortality (adjusted HR for 7+ portions 0.67 (95% CI 0.58 to 0.78), reference category <1 portion). This association was more pronounced when excluding deaths within a year of baseline (0.58 (0.46 to 0.71)). Fruit and vegetable consumption was associated with reduced cancer (0.75 (0.59–0.96)) and cardiovascular mortality (0.69 (0.53 to 0.88)). Vegetables may have a stronger association with mortality than fruit (HR for 2 to 3 portions 0.81 (0.73 to 0.89) and 0.90 (0.82 to 0.98), respectively). Consumption of vegetables (0.85 (0.81 to 0.89) per portion) or salad (0.87 (0.82 to 0.92) per portion) were most protective, while frozen/canned fruit consumption was apparently associated with increased mortality (1.17 (1.07 to 1.28) per portion). Conclusions A robust inverse association exists between fruit and vegetable consumption and mortality, with benefits seen in up to 7+ portions daily. Further investigations into the effects of different types of fruit and vegetables are warranted

Diabetes mellitus and mortality from all-causes, cancer, cardiovascular and respiratory disease: Evidence from the Health Survey for England and Scottish Health Survey cohorts.

Diabetes mellitus is associated with differing rates of all-cause and cause-specific mortality compared with the general population; although the strength of these associations requires further investigation. The effects of confounding factors, such as overweight and obesity and the presence of co-morbid cardiovascular disease (CVD), upon such associations also remain unclear. There is thus a need for studies which utilise data from nationally-representative samples to explore these associations further

Epidemiological evidence of a relationship between type-1 diabetes mellitus and cancer: a review of the existing literature.

This review explores the epidemiological evidence relating to type-1 diabetes (T1DM) and cancer incidence and mortality. Mortality rates among those with T1DM are higher in every age group compared with the general population; the majority of this mortality is due to factors related to the consequences of diabetes, such as cardiovascular and renal disease. For over 100 years, researchers have explored the relationships between diabetes and cancer and although there is now a large body of work on the subject, consensus has not been reached. Such research has tended to focus upon type-2 diabetes, with the result that very little is known about T1DM and cancer. As incidence of T1DM increases, by around 3% annually among children, the need for further research into its impact upon cancer incidence and mortality increases. Within this review, findings varied by study method utilised, T1DM definition used and study region and outcome measure explored. None of the case-control studies found a statistically significant link between the two diseases, whereas both of the meta-analyses did. Cohort studies produced mixed results. There were also mixed findings among research that defined T1DM in the same way (e.g. defining individuals with the disease as those diagnosed with diabetes before 30 years of age). The review found a number of studies which explored cause-specific cancer mortality among those with diabetes; such studies also had mixed findings. This inconsistency within results suggests the need for further research to understand better the potential relationships between T1DM and cancer

Fully adjusted (age, sex, smoking, SES and BMI) all-cause mortality survival curves by HbA1_C and diabetes category (whole sample).

<p>Fully adjusted (age, sex, smoking, SES and BMI) all-cause mortality survival curves by HbA1_C and diabetes category (whole sample).</p