, Volume 61, Issue 5, pp 1089–1097 | Cite as

Hyperglycaemia is associated with cancer-related but not non-cancer-related deaths: evidence from the IPC cohort

  • Jean-Marc Simon
  • Frederique Thomas
  • Sebastien Czernichow
  • Olivier Hanon
  • Cedric Lemogne
  • Tabassome Simon
  • Bruno Pannier
  • Nicolas Danchin



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.


Cancer 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.

Contribution statement

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.


  1. 1.
    Giovannucci E, Harlan DM, Archer MC et al (2010) Diabetes and cancer: a consensus report. CA Cancer J Clin 60:207–221CrossRefPubMedGoogle Scholar
  2. 2.
    Noto H, Tsujimoto T, Sasazuki T, Noda M (2011) Significantly increased risk of cancer in patients with diabetes mellitus: a systematic review and meta-analysis. Endocr Pract 17:616–628CrossRefPubMedGoogle Scholar
  3. 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
  4. 4.
    Luo J, Lin HC, He K, Hendryx M (2014) Diabetes and prognosis in older persons with colorectal cancer. Br J Cancer 111:1847–1854CrossRefGoogle Scholar
  5. 5.
    Hirakawa Y, Ninomiya T, Mukai N et al (2012) Association between glucose tolerance level and cancer death in a general Japanese population: the Hisayama Study. Am J Epidemiol 176:856–864CrossRefPubMedGoogle Scholar
  6. 6.
    Wulaningsih W, Holmberg L, Garmo H et al (2013) Serum glucose and fructosamine in relation to risk of cancer. PLoS One 8:e54944CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    DeCensi A, Puntoni M, Goodwin P et al (2010) Metformin and cancer risk in diabetic patients: a systematic review and meta-analysis. Cancer Prev Res (Phila) 3:1451–1461CrossRefGoogle Scholar
  8. 8.
    Colmers IN, Bowker SL, Tjosvold LA, Johnson JA (2012) Insulin use and cancer risk in patients with type 2 diabetes: a systematic review and meta-analysis of observational studies. Diabete Metab 38:485–506CrossRefPubMedGoogle Scholar
  9. 9.
    Bordeleau L, Yakubovich N, Dagenais GR et al (2014) The association of basal insulin glargine and/or n-3 fatty acids with incident cancers in patients with dysglycemia. Diabetes Care 37:1360–1366CrossRefPubMedGoogle Scholar
  10. 10.
    Rothwell PM, Price JF, Fowkes FGR et al (2012) Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet 379:1602–1612CrossRefPubMedGoogle Scholar
  11. 11.
    Algra AM, Rothwell PM (2012) Effects of regular aspirin on long-term cancer incidence and metastasis: a systematic comparison of evidence from observational studies versus randomised trials. Lancet Oncol 13:518–527CrossRefPubMedGoogle Scholar
  12. 12.
    US Preventive Services Task Force (2016) Aspirin use to prevent cardiovascular disease and colorectal cancer: preventive medication. Available from Assessed 23 Mar 2017
  13. 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
  14. 14.
    Sieri S, Muti P, Claudia A et al (2012) Prospective study on the role of glucose metabolism in breast cancer occurrence. Int J Cancer 130:921–929CrossRefPubMedGoogle Scholar
  15. 15.
    Contiero P, Berrino F, Tagliabue G et al (2013) Fasting blood glucose and long-term prognosis of non-metastatic breast cancer: a cohort study. Breast Cancer Res Treat 138:951–959CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Boyle P, Koechlin A, Pizot C et al (2013) Blood glucose concentrations and breast cancer risk in women without diabetes: a meta-analysis. Eur J Nutr 52:1533–1540CrossRefPubMedGoogle Scholar
  17. 17.
    Luo J, Chen YJ, Chang LJ (2012) Fasting blood glucose level and prognosis in non-small cell lung cancer (NSCLC) patients. Lung Cancer 76:242–247CrossRefPubMedGoogle Scholar
  18. 18.
    Liao WC, Tu YK, Wu MS, Lin JT, Wang HP, Chien KL (2015) Blood glucose concentration and risk of pancreatic cancer: systematic review and dose-response meta-analysis. BMJ 349:g7371CrossRefGoogle Scholar
  19. 19.
    Wolpin BM, Bao Y, Rong Qian Z et al (2013) Hyperglycemia, insulin resistance, impaired pancreatic β-cell function, and risk of pancreatic cancer. J Natl Cancer Inst 105:1027–1035CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Bhaskaran K, Douglas I, Forbes H, Dos Santos SI, Leon DA, Smeeth L (2014) Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5.24 million UK adults. Lancet 384:755–765CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    García-Jiménez C, Gutiérrez-Salmerón M, Chocarro-Calvo A, García-Martinez JM, Castaño A, De la Vieja A (2016) From obesity to diabetes and cancer: epidemiological links and role of therapies. Br J Cancer 114:716–722CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Klil-Drori AJ, Azoulay L, Pollak MN (2017) Cancer, obesity, diabetes, and antidiabetic drugs: is the fog clearing? Nat Rev Clin Oncol 14:85–99CrossRefPubMedGoogle Scholar
  23. 23.
    Goto A, Noda M, Sawada N et al (2016) High hemoglobin A1c levels within the non-diabetic range are associated with the risk of all cancers. Int J Cancer 138:1741–1753CrossRefPubMedGoogle Scholar
  24. 24.
    Zhou X, Qiao Q, Zethelius B et al (2010) Diabetes, prediabetes and cancer mortality. Diabetologia 53:1867–1876CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jean-Marc Simon
    • 1
    • 2
  • Frederique Thomas
    • 1
  • Sebastien Czernichow
    • 3
    • 4
  • Olivier Hanon
    • 1
    • 5
  • Cedric Lemogne
    • 3
    • 4
    • 6
  • Tabassome Simon
    • 7
  • Bruno Pannier
    • 1
    • 8
  • Nicolas Danchin
    • 1
    • 3
    • 9
  1. 1.Centre IPCParisFrance
  2. 2.Hopital Pitié Salpétrière, APHPParisFrance
  3. 3.Hopital HEGP, APHPParisFrance
  4. 4.Hôpitaux Universitaires Paris Ouest, APHPParisFrance
  5. 5.Hopital Broca, APHPParisFrance
  6. 6.Inserm U894, Centre Psychiatrie et NeurosciencesParisFrance
  7. 7.Hopital Saint Antoine, APHP, Université Pierre et Marie CurieParisFrance
  8. 8.Hopital ManhèsFleury-MerogisFrance
  9. 9.Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecineParisFrance

Personalised recommendations