Cancer overtakes vascular disease as leading cause of excess death associated with diabetes

Cardiovascular disease is a common complication of diabetes with an estimated prevalence of 27%. 1 Litwak L Goh SY Hussein Z Malek R Prusty V Khamseh ME Prevalence of diabetes complications in people with type 2 diabetes mellitus and its association with baseline characteristics in the multinational A1chieve study. Diabetol Metab Syndr. 2013; 5: 57 Crossref PubMed Scopus (146) Google Scholar Thus, the two diseases are frequently grouped together and termed as cardiometabolic diseases. Although another major cause of death, cancer, has been traditionally considered as a distinct spectrum of disease, increasing evidence supports the importance of metabolic disturbances in the cause of cancer. Compared with individuals without diabetes, those with diabetes are nearly twice as likely to develop liver and pancreatic cancer (similar effect size to that for cardiovascular disease in patients with diabetes), 1·5–2·0 times more likely to develop endometrial and gallbladder cancer, and 1·1–1·4 times more likely to develop kidney, colorectal, bladder, and breast cancer. 2 Ling S Brown K Miksza JK et al. Association of type 2 diabetes with cancer: a meta-analysis with bias analysis for unmeasured confounding in 151 cohorts comprising 32 million people. Diabetes Care. 2020; 43: 2313-2322 Crossref PubMed Scopus (44) Google Scholar Globally, an estimated 5·7% of all incident cancers in 2012 were attributable to the combined effects of adiposity and diabetes. 3 Pearson-Stuttard J Zhou B Kontis V Bentham J Gunter MJ Ezzati M Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment. Lancet Diabetes Endocrinol. 2018; 6: e6-15 Summary Full Text Full Text PDF PubMed Scopus (168) Google Scholar Therefore, cancer might, to some degree, be considered in the broad spectrum of cardiometabolic disorders and a group of complications of diabetes. Also, as reduction in cancer mortality continues to lag behind that of cardiovascular disease for which extensive prevention measures, including dietary and lifestyle interventions and treatment of hyperlipidaemia and other risk factors, have been widely implemented, 4 Song M Vogelstein B Giovannucci EL Willett WC Tomasetti C Cancer prevention: molecular and epidemiologic consensus. Science. 2018; 361: 1317-1318 Crossref PubMed Scopus (42) Google Scholar cancer is projected to surpass ischaemic heart disease to become the leading cause of death by approximately 2030 worldwide. Trends in predominant causes of death in individuals with and without diabetes in England from 2001 to 2018: an epidemiological analysis of linked primary care recordsThe decline in vascular death rates has been accompanied by a diversification of causes in individuals with diagnosed diabetes and a transition from vascular diseases to cancers as the leading contributor to diabetes-related death. Clinical and preventative approaches must reflect this trend to reduce the excess mortality risk in individuals with diabetes. Full-Text PDF Open Access