Table 3.
Pooled association between diabetes duration and cancer incidence (NHS: 1978-2014; HPFS: 1988-2014)a
| Cancer outcomes | Diabetes duration |
|||||||
|---|---|---|---|---|---|---|---|---|
| No diabetes | 0-2.0 years | 2.1-4.0 years | 4.1-6.0 years | 6.1-8.0 years | 8.1-10.0 years | 10.1-15.0 years | >15.0 years | |
| Total cancer | ||||||||
| Case/person-year | 39 902/4 052 767 | 742/47 747 | 503/35 168 | 524/31 214 | 503/27 103 | 380/22 500 | 681/40 008 | 614/37 058 |
| Multivariable adjusted model, HR (95% CI)b | (Referent) | 1.34 (1.25 to 1.45) | 1.18(1.08 to 1.30) | 1.34 (1.23 to 1.47) | 1.44 (1.32 to 1.58) | 1.28 (1.15 to 1.42) | 1.23 (1.13 to 1.33) | 1.10 (1.01 to 1.20) |
| Additionally adjusted for BMI, HR (95% CI)c | (Referent) | 1.29 (1.19 to 1.38) | 1.13 (1.03 to 1.24) | 1.28 (1.17 to 1.40) | 1.37 (1.25 to 1.50) | 1.21 (1.09 to 1.35) | 1.16 (1.07 to 1.26) | 1.04 (0.95 to 1.14) |
| Obesity-related cancerd | ||||||||
| Case/person-year | 19 844/4 068 736 | 433/48 003 | 278/35 340 | 287/31 399 | 274/27 256 | 192/22 634 | 358/40 226 | 311/37 262 |
| Multivariable adjusted model, HR (95% CI)b | (Referent) | 1.53 (1.39 to 1.68) | 1.29 (1.14 to 1.46) | 1.47 (1.30 to 1.65) | 1.59 (1.40 to 1.80) | 1.31 (1.13 to 1.52) | 1.32 (1.18 to 1.47) | 1.15 (1.02 to 1.30) |
| Additionally adjusted for BMI, HR (95% CI)c | (Referent) | 1.42 (1.28 to 1.56) | 1.19 (1.05 to 1.34) | 1.35 (1.19 to 1.52) | 1.45 (1.28 to 1.65) | 1.19 (1.03 to 1.39) | 1.20 (1.07 to 1.34) | 1.05 (0.92 to 1.19) |
| Diabetes-related cancere | ||||||||
| Case/person-year | 24 484/4 064 614 | 497/47 943 | 302/35 324 | 331/31 364 | 310/27 237 | 223/22 612 | 400/40 195 | 357/37 232 |
| Multivariable adjusted model, HR (95% CI)b | (Referent) | 1.49 (1.36 to 1.63) | 1.20 (1.06 to 1.34) | 1.44 (1.28 to 1.61) | 1.52 (1.35 to 1.70) | 1.29 (1.13 to 1.48) | 1.25 (1.12 to 1.39) | 1.14 (1.01 to 1.28) |
| Additionally adjusted for BMI, HR (95% CI)c | (Referent) | 1.40 (1.28 to 1.53) | 1.12 (1.00 to 1.26) | 1.34 (1.20 to 1.50) | 1.41 (1.26 to 1.59) | 1.21 (1.05 to 1.38) | 1.16 (1.04 to 1.29) | 1.05 (0.94 to 1.18) |
| Colorectal cancer | ||||||||
| Case/person-year | 3275/4 083 317 | 66/48 325 | 41/35 547 | 48/31 608 | 45/27 450 | 42/22 767 | 48/40 484 | 48/37 485 |
| Multivariable adjusted model, HR (95% CI)b | (Referent) | 1.34 (1.05 to 1.72) | 1.10 (0.80 to 1.51) | 1.43 (1.07 to 1.92) | 1.50 (1.10 to 2.03) | 1.66 (1.20 to 2.28) | 1.14 (0.85 to 1.54) | 1.08 (0.79 to 1.48) |
| Additionally adjusted for BMI, HR (95% CI)c | (Referent) | 1.25 (0.98 to 1.60) | 1.02 (0.75 to 1.40) | 1.33 (0.99 to 1.79) | 1.39 (1.02 to 1.89) | 1.54 (1.12 to 2.12) | 1.05 (0.78 to 1.42) | 1.00 (0.73 to 1.38) |
| Lung cancer | ||||||||
| Case/person-year | 3455/4 084 133 | 62/48 353 | 44/35 550 | 49/31 616 | 42/27 461 | 36/22 788 | 71/40 483 | 55/37 500 |
| Multivariable adjusted model, HR (95% CI)b | (Referent) | 1.23 (0.95 to 1.58) | 1.13 (0.83 to 1.52) | 1.35 (1.01 to 1.81) | 1.31 (0.96 to 1.79) | 1.25 (0.90 to 1.76) | 1.28 (1.00 to 1.65) | 0.99 (0.75 to 1.32) |
| Additionally adjusted for BMI, HR (95% CI)c | (Referent) | 1.28 (0.99 to 1.65) | 1.18 (0.87 to 1.60) | 1.43 (1.07 to 1.92) | 1.37 (1.00 to 1.87) | 1.32 (0.94 to 1.85) | 1.36 (1.06 to 1.75) | 1.05 (0.79 to 1.40) |
| Pancreatic cancer | ||||||||
| Case/person-year | 874/4 085 780 | 39/48 368 | 15/35 575 | 25/31 640 | 21/27 479 | 20/22 800 | 24/40 516 | 31/37 520 |
| Multivariable adjusted model, HR (95% CI)b | (Referent) | 2.91 (2.10 to 4.04) | 1.43 (0.85 to 2.40) | 2.48 (1.64 to 3.73) | 2.36 (1.51 to 3.68) | 2.48 (1.57 to 3.92) | 1.52 (0.99 to 2.33) | 1.76 (1.17 to 2.65) |
| Additionally adjusted for BMI, HR (95% CI)c | (Referent) | 2.82 (2.03 to 3.92) | 1.37 (0.81 to 2.31) | 2.38 (1.58 to 3.61) | 2.30 (1.47 to 3.60) | 2.41 (1.52 to 3.81) | 1.46 (0.95 to 2.25) | 1.67 (1.11 to 2.52) |
| Breast cancer | ||||||||
| Case/person-year | 12 064/3 172 217 | 211/34 162 | 134/25 748 | 147/23 168 | 129/20 327 | 69/17 051 | 170/30 982 | 153/32 132 |
| Multivariable adjusted model, HR (95% CI)b | (Referent) | 1.44 (1.26 to 1.66) | 1.21 (1.01 to 1.44) | 1.48 (1.25 to 1.75) | 1.47 (1.23 to 1.76) | 0.93 (0.73 to 1.19) | 1.26 (1.06 to 1.48) | 1.13 (0.94 to 1.34) |
| Additionally adjusted for BMI, HR (95% CI)c | (Referent) | 1.40 (1.22 to 1.61) | 1.17 (0.98 to 1.40) | 1.44 (1.21 to 1.71) | 1.43 (1.19 to 1.71) | 0.91 (0.71 to 1.16) | 1.22 (1.04 to 1.44) | 1.10 (0.92 to 1.31) |
| Endometrial cancer | ||||||||
| Case/person-year | 1799/3 181 864 | 55/34 343 | 34/25 834 | 30/23 283 | 30/20 422 | 24/17 101 | 43/31 095 | 25/32 266 |
| Multivariable adjusted model, HR (95% CI)b | (Referent) | 2.25 (1.71 to 2.97) | 1.82 (1.28 to 2.59) | 1.74 (1.19 to 2.54) | 1.92 (1.31 to 2.80) | 1.81 (1.18 to 2.77) | 1.68 (1.20 to 2.36) | 0.97 (0.63 to 1.50) |
| Additionally adjusted for BMI, HR (95% CI)c | (Referent) | 1.63 (1.24 to 2.15) | 1.30 (0.91 to 1.86) | 1.22 (0.84 to 1.78) | 1.34 (0.91 to 1.96) | 1.24 (0.81 to 1.90) | 1.14 (0.81 to 1.60) | 0.65 (0.42 to 1.01) |
Only cancers that showed associations with incident type 2 diabetes in Table 2 were presented. Estimates were meta-analyzed using a random-effect model. BMI = body mass index; CI = confidence interval; HPFS = Health Professionals Follow-up Study; HR = hazard ratio; NHS = Nurses’ Health Study.
Adjusting for age (month), ethnicity (White, African American, Asian, others), smoking status (never smoked, past smoker, currently smoke 1-14 cigarettes per day, 15-24 cigarettes per day, or ≥25 cigarettes per day), alcohol intake (0, 0.1-4.9, 5.0-9.9, 10.0-14.9, 15.0-29.9, and ≥30.0 g/d), multivitamin use (yes, no), physical activity (quintiles), total energy (quintiles), alternative healthy eating index (quintiles), family history of diabetes (yes, no), family history of cancer (yes, no), endoscopy screening (yes, no), and fasting glucose screening (yes, no). For women, insulin use (yes, no), oral hypoglycemic drug use (yes, no), mammography screening, postmenopausal hormone use (never, former, or current hormone use, or missing), and oral contraceptive use were further adjusted.
Cumulative-averaged BMI (calculated as weight in kilograms divided by height in meters squared) (<21.0, 21.0-22.9, 23.0-24.9, 25.0-26.9, 27.0-29.9, 30.0-32.9, 33.0-34.9, or ≥35.0 kg/m2) was additionally adjusted.
Including esophagus cancer, liver cancer, kidney cancer, myeloma, pancreatic cancer, colorectal cancer, gallbladder cancer, postmenopausal breast cancer, ovarian cancer, and thyroid cancer.
Including thyroid cancer, breast cancer, liver cancer, pancreatic cancer, endometrial cancer, esophagus cancer, colorectal cancer, kidney cancer, gallbladder cancer, ovarian cancer, non-Hodgkin lymphoma, leukemia, and bladder cancer.