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Diabetes and cause-specific mortality
in a prospective cohort of one million u.s. Adults.

Diabetes Care. 2012 Sep;35(9):1835-44. Epub 2012 Jun 14.
Campbell PT, Newton CC, Patel AV, Jacobs EJ, Gapstur SM.

Les causes de mortalité autres que cardiovasculaires chez le diabétique
Dans cette grande étude (1 millions d'adultes US sur 10 années) prospective des facteurs de risque de cancer, la Cancer Prevention Study (CPS), suivis de 1982 à 1998, un diabète auto-rapporté à l'inclusion est associé à un risque accru de décès par cancers du côlon, du pancréas, ainsi que par cancer du sein chez les femmes et par cancers du foie et de la vessie chez les hommes. Elle a confirmé la relation entre diabète et risque avec des cancers relativement rares (cancer du sein chez l'homme, par exemple). La vigilance "tous azimuths" s'impose...

OBJECTIVE
Diabetes is a major predictor of death from heart disease and stroke; its impact on nonvascular mortality, including specific cancers, is less understood. We examined the association of diabetes with cause-specific mortality, including deaths from specific cancers.

RESEARCH DESIGN AND METHODS
A prospective cohort of 1,053,831 U.S. adults, without cancer at baseline, enrolled in the Cancer Prevention Study-II in 1982 and was followed for mortality until December 2008. At baseline, participants completed a self-administered questionnaire that included information on diabetes, smoking, physical activity, height, and weight. Multivariable-adjusted relative risks (RRs) (95% CI) were estimated using Cox proportional hazards regression.

RESULTS
During 26 years of follow-up, 243,051 men and 222,109 women died. In multivariable models that controlled for age, BMI, and other variables, diabetes was associated with higher risk of all-cause mortality (women RR 1.90 [95% CI 1.87-1.93]; men 1.73 [1.70-1.75]).
    Among women, diabetes was associated with higher risk of death from cancers of
  • the liver (1.40 [1.05-1.86]),
  • pancreas (1.31 [1.14-1.51]),
  • endometrium (1.33 [1.08-1.65]),
  • colon (1.18 [1.04-1.33]),
  • breast (1.16 [1.03-1.29]).

    Among men, diabetes was associated with risk of death from cancers of
  • the breast (4.20 [2.20-8.04]),
  • liver (2.26 [1.89-2.70]),
  • oral cavity and pharynx (1.44 [1.07-1.94]),
  • pancreas (1.40 [1.23-1.59]), bladder (1.22 [1.01-1.47]), colon (1.15 [1.03-1.29]), and (inversely) prostate (0.88 [0.79-0.97]).
    Diabetes was also associated with higher risks of death involving the circulatory system, respiratory system, digestive system, genitourinary system, and external causes/accidental deaths.
CONCLUSIONS
Diabetes is associated with higher risk of death for many diseases, including several specific forms of cancer.

PMID: 22699290 [PubMed - in process] PMCID: PMC3425000 [Available on 2013/9/1]
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