Cancer is becoming the leading cause of death in diabetes

Abstract

In their Seminar on type 2 diabetes, Ehtasham Ahmad and colleagues1Ahmad E Lim S Lamptey R Webb DR Davies MJ Type 2 diabetes.Lancet. 2022; 400: 1803-1820Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar highlighted the current and future global burden of disease and correctly stated that the increased risk of premature death from this chronic condition is mainly driven through the detrimental effects on vascular integrity. Accordingly, many national guidelines recommend secondary prevention of cardiovascular disease. We would like to draw attention to three studies from the past 10 years indicating that cancer is, or is predicted to become, the leading cause of diabetes-related death. An Australian study from 2014 reported on cause-specific mortality trends in over 1·1 million people with diabetes (1997–2010), and noted that cardiovascular disease was the most common contributor to death, but rates had declined.2Harding JL Shaw JE Peeters A Guiver T Davidson S Magliano DJ Mortality trends among people with type 1 and type 2 diabetes in Australia: 1997–2010.Diabetes Care. 2014; 37: 2579-2586Crossref PubMed Scopus (105) Google Scholar By contrast, cancer deaths had increased, becoming the second most common cause of death in Australia. In 2021, Pearson-Stuttard and colleagues3Pearson-Stuttard J Bennett J Cheng YJ et al.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 records.Lancet Diabetes Endocrinol. 2021; 9: 165-173Summary Full Text Full Text PDF PubMed Scopus (92) Google Scholar evaluated causes of death trends in over 300 000 individuals with diabetes in England (2001–18). They concluded that “the decline in vascular death rates has been accompanied by….a transition…to cancers as the leading contributor to diabetes-related death”. Similarly, mortality trends in Swedish National Diabetes Registry data predict that cancer will be the leading cause of death among individuals with diabetes by 2030.4Bjornsdottir HH Rawshani A Rawshani A et al.A national observation study of cancer incidence and mortality risks in type 2 diabetes compared to the background population over time.Sci Rep. 2020; 1017376 Crossref Scopus (24) Google Scholar This changeover reflects declining cardiovascular disease mortality through improved prevention, coupled with increasing cancer-related mortality, in part reflecting increased cancer incidence secondary to the survival advantage afforded through cardiovascular disease prevention. It is time to widen secondary prevention efforts in people with diabetes to reducing cancer incidence and, among those with diabetes who develop cancer, improving cancer survival, ultimately avoiding many premature deaths. We declare no competing interests. Type 2 diabetesType 2 diabetes accounts for nearly 90% of the approximately 537 million cases of diabetes worldwide. The number affected is increasing rapidly with alarming trends in children and young adults (up to age 40 years). Early detection and proactive management are crucial for prevention and mitigation of microvascular and macrovascular complications and mortality burden. Access to novel therapies improves person-centred outcomes beyond glycaemic control. Precision medicine, including multiomics and pharmacogenomics, hold promise to enhance understanding of disease heterogeneity, leading to targeted therapies. Full-Text PDF Cancer is becoming the leading cause of death in diabetes – Authors' replyWe thank Mengying Wang and colleagues for their very insightful comments on our Seminar on type 2 diabetes.1 They have drawn our attention to the fact that cancer is, or is predicted to become, the leading cause of diabetes-related death in the coming years, overtaking cardiovascular disease. We acknowledge that cancer rates are rising in people with type 2 diabetes. Indeed, in January, 2023, our team at Leicester Diabetes Research Centre published data demonstrating a transition from cardiovascular disease to cancer deaths in type 2 diabetes. Full-Text PDF