Hyperglycaemia is associated with cancer-related but not non-cancer-related deaths: evidence from the IPC cohort
- 418 Downloads
Hyperglycaemia has been associated with the incidence of all and specific types of cancer, distinct from the risks related to diabetes. The relationships between blood glucose and mortality rates related to all and specific cancers were analysed in comparison with all-cause or non-cancer-related mortality rates in a large, general primary care population in France.
Between January 1991 and December 2008, 301,948 participants (193,221 men and 108,727 women), aged 16–95 years (mean ± SD 44.8 ± 12.0 years for men and 45.1 ± 14.2 years for women), had a health check at the IPC Centre. All data collected in standard conditions during the health checks-up were used for statistical analysis All examinations were performed under fasting conditions and included a blood glucose measurement. Participants with known diabetes (<9%) were excluded from the analysis. Participants were classified into quintiles based on their blood glucose measurement and were followed for a maximum of 17 years (mean ± SD 9.2 ± 4.7 years) to assess all-cause, cancer and non-cancer mortality rates.
A non-linear relationship was observed between cancer mortality rates and blood glucose quintile after adjustment for age and sex. There was a significant association between the group with the highest blood glucose level and cancer-related death (multivariate Cox model, HR [95% CI] 1.17 [1.03, 1.34]), while the group with normoglycaemia showed no association with cancer-related deaths. We did not observe a relationship between blood glucose and all-cause or non-cancer mortality rates. An excess risk of death was observed in the highest blood glucose quintile for gastrointestinal cancer and leukaemia. Adjustments for diabetes and aspirin use did not modify the results. However, this excess risk disappeared with use of glucose-lowering agents (HR [95% CI] 1.03 [0.74, 1.43]).
Hyperglycaemia is associated with significantly higher rates of cancer-related deaths, particularly in gastrointestinal cancer and leukaemia, but not with non-cancer-related deaths. The association is retained when taking into account confounding factors, including chronic aspirin treatment.
KeywordsCancer Epidemiology Hyperglycaemia Mortality
Apolipoprotein MOrtality RISk
- IPC Centre
Centre d’Investigations Préventives et Cliniques
We thank the Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAM-TS, France) and the Caisse Primaire d’Assurance Maladie de Paris (CPAM-P, France) for their help in making this study possible.
JMS, BP and FT made substantial contributions to conception, design, interpretation of the results and drafting of the manuscript. FT performed the statistical analysis. SC, OH, CL, TS, ND contributed to the conception and design of the study, interpretation of the data and critically revised the manuscript for important intellectual content. All authors approved the final manuscript to be published. BP is guarantor and is therefore responsible for the integrity of the work as a whole.
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
- 3.Chen Y, Wu F, Saito E et al (2017) Association between type 2 diabetes and risk of cancer mortality: a pooled analysis of over 771,000 individuals in the Asia Cohort Consortium. Diabetologia 60:1022–1032Google Scholar
- 12.US Preventive Services Task Force (2016) Aspirin use to prevent cardiovascular disease and colorectal cancer: preventive medication. Available from www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/aspirin-to-prevent-cardiovascular-disease-and-cancer?ds=1&s=aspirin%20cancer. Assessed 23 Mar 2017
- 13.Svensson E, Baggesen LM, Johnsen SP et al (2017) Early glycemic control and magnitude of HbA(1c) reduction predict cardiovascular events and mortality: population-based cohort study of 24,752 metformin initiators. Diabetes Care 40:800–807Google Scholar