Prior History Of Diabetes Mellitus Research Articles

A Case of an Accelerated Uremic Neuropathy

We present a 62-year-old man, with a prior history of diabetes mellitus, atherosclerotic heart disease, and chronic renal failure requiring peritoneal dialysis, who developed accelerated uremic sensorimotor polyneuropathy. Our patient significantly improved after effective hemodialysis. Although renal transplantation is a curable therapy for uremic neuropathy, effective dialysis is still an important treatment for the group of patients who cannot undergo renal transplantation.

E0453 Effect of blood pressure levels on prognosis in patients of non st segment elevated acute coronary syndrome without prior history of hypertension

BackgroundHypertension was an independent risk factor for affecting the prognosis of patients with ACS. But the effect of blood pressure levels at admission on prognosis in ACS patients without history...

Emergency Department Hyperglycemia as a Predictor of Early Mortality and Worse Functional Outcome after Intracerebral Hemorrhage

We have previously reported the association of hyperglycemia and mortality after ischemic stroke. This study attempts to answer the hypothesis, if hyperglycemia at arrival, is associated with early mortality and functional outcome in patients with acute non-traumatic intracerebral hemorrhage (ICH). The study cohort consisted of 237 patients who presented to the ED with ICH and had blood glucose measured on ED presentation. The presence of hyperglycemia on presentation was correlated with outcome measures including volume of hematoma, intraventricular extension of hematoma (IVE), stroke severity, functional outcome at discharge, and date of death. Of the cohort of 237 patients, a total of 47 patients had prior history of Diabetes Mellitus (DM). Median blood glucose at presentation was 140 mg/dl (Inter-quartile range 112-181 mg/dl). DM patients had higher glucose levels on arrival (median 202 mg/dl for DM vs. 132.5 mg/dl for non-DM, P < 0.0001). Higher blood glucose at ED arrival was associated with early mortality in both non-diabetics and diabetics (P < 0.0001). Higher blood glucose was associated with poor functional outcome in non-DM patients(P < 0.0001) but not in DM patients (P = 0.268). In the logistic regression model, after adjustment for stroke severity, hematoma volume, and IVE of hemorrhage, higher initial blood glucose was a significant predictor of death (P = 0.0031); as well as bad outcome in non-DM patients (P = 0.004). Hyperglycemia on presentation in non-diabetic patients is an independent predictor of early mortality and worse functional outcome in patients with intracerebral hemorrhage.

Nodular glomerulosclerosis in patients' without history of diabetes mellitus: a case report

IntroductionDiabetic nephropathy can occur during the course of both type1 and type 2 diabetes mellitus. The characteristic lesions are diffuse or nodular (Kimmelsteil-Wilson) diabetic glomerulosclerosis. The reported cases represent unusual presentations of diabetes mellitus.Case presentationWe report the case of a 49-year-old man without prior history of diabetes mellitus who presented with rapidly progressive renal failure and whose renal biopsy revealed nodular (Kimmelsteil-Wilson) glomerulosclerosis lesions characteristic of diabetes.ConclusionRenal manifestations of diabetes mellitus may antedate other more common presenting symptoms of this disease and we critically review the literature on this subject.

Perioperative insulin therapy using a closed-loop artificial endocrine pancreas after hepatic resection

Postoperative hyperglycemia is common in critically ill patients, even in those without a prior history of diabetes mellitus. It is well known that hyperglycemia induced by surgical stress often results in dysregulation of liver metabolism and immune function, impairing postoperative recovery. Current evidence suggests that maintaining normoglycemia postoperatively improves surgical outcome and reduces the mortality and morbidity of critically ill patients. On the basis of these observations, several large randomized controlled studies were designed to evaluate the benefit of postoperative tight glycemic control with intensive insulin therapy. However, intensive insulin therapy carries the risk of hypoglycemia, which is linked to serious neurological events. Recently, we demonstrated that perioperative tight glycemic control in surgical patients could be achieved safely using a closed-loop glycemic control system and that this decreased both the incidence of infection at the site of the surgical incision, without the appearance of hypoglycemia, and actual hospital costs. Here, we review the benefits and requirements of perioperative intensive insulin therapy using a closed-loop artificial endocrine pancreas system in hepatectomized patients. This novel intensive insulin therapy is safe and effectively improves surgical outcome after hepatic resection.

187: Hyperglycemia as a Predictor of Death in Patients With Transient Ischemic Attack and No Prior History of Diabetes Mellitus

To determine if differences in mortality exist between diabetic and non-diabetic patients who present to the emergency department (ED) with transient ischemic attack and elevated blood glucose.

Hyperglycemia as a Predictor of In‐Hospital Mortality in Elderly Patients without Diabetes Mellitus Admitted to a Sub‐Intensive Care Unit

To investigate the association between hyperglycemia and in-hospital and 45-day mortality in acutely ill elderly patients. Retrospective cohort. Hospital medical patients admitted to a sub-intensive care unit (sub-ICU) for elderly patients, which is a level of care between ordinary wards and intensive care. One thousand two hundred twenty-nine patients (mean age 79.6+/-8.4) admitted to the sub-ICU from January 2003 to January 2006. Forty patients with acute myocardial infarction and 34 patients with extreme fasting glucose values (<60 or >500 mg/dL) were excluded. Eight hundred twenty-two patients without a history of diabetes mellitus (DM) and 333 patients with a diagnosis of DM were selected and subdivided into three categories according to serum fasting blood glucose: 60 to 126 mg/dL (Group A), 127 to 180 mg/dL (Group B), and 181 to 500 mg/dL (Group C). Age, sex, mental and functional status, Acute Physiology Score, comorbid conditions, serum albumin, serum cholesterol, fasting serum glucose, and length of stay. In-hospital mortality was the primary outcome, and 45-day mortality was the secondary outcome. Total in-hospital mortality was 14.5%. In patients with and without DM, mortality was 8.8% and 11.3%, respectively, in Group A; 13.6% and 17.3% in Group B, and 12.6% and 34.3% in Group C. After controlling for confounders, newly recognized hyperglycemia (>181 mg/dL) was independently associated with in-hospital mortality (adjusted odds ratio=2.7, 95% confidence interval=1.6-4.8). Forty-five-day mortality in newly recognized hyperglycemic patients was 17.5%, 25.7%, and 42% in Groups A, B, and C, respectively, whereas it was 21.2% in patients with DM. In elderly patients, newly recognized hyperglycemia was associated with a higher mortality rate than in those with a prior history of DM. These data suggest that further randomized clinical trials are needed to assess the efficacy and the risk of a target glucose of greater than 180 mg/dL.

Hyperglycemia as An Independent Predictor of Worse Outcome in Non-diabetic Patients Presenting with Acute Ischemic Stroke

To determine if differences in outcome exist between diabetic and non-diabetic patients who present to the Emergency Department (ED) with acute ischemic stoke (AIS) and elevated blood glucose. The study population consisted of 447 consecutive patients who presented to the ED with AIS within 24 h of symptom onset and had blood glucose measured on presentation. Hyperglycemia was defined as >130 mg/dl. Outcomes studied included infarct volume, stroke severity (NIH Stroke Scale), functional impairment (modified Rankin Score), and 90-day mortality. Patients with hyperglycemia were then stratified into those with and without a prior history of diabetes mellitus (DM) for the purposes of analysis. Patients with hyperglycemia exhibited significantly greater stroke severity (P = 0.002) and greater functional impairment (P = 0.004) than those with normoglycemia. Patients with hyperglycemia were 2.3 times more likely to be dead at 90 days compared to those with normal glucose (P < 0.001). Stroke severity (P < 0.001) and functional impairment (P < 0.001) were both significantly worse in patients with hyperglycemia and no prior history of DM, when compared to patients with hyperglycemia and previously diagnosed DM. Among the patients without a prior history of DM, patients with hyperglycemia were 3.4 times more likely to die within 90 days (P < 0.001) when compared with patients with normoglycemia. In contrast, the hazard ratio was 1.6 among the patients with DM (P = 0.66). Hyperglycemia on presentation is associated with significantly poorer outcomes following AIS. Patients with hyperglycemia and no prior history of DM have a particularly poor prognosis, worse than that for patients with known diabetes and hyperglycemia.

Implications and Treatment of Acute Hyperglycemia in the Setting of Acute Myocardial Infarction

A 52-year-old obese male without a prior history of diabetes mellitus (DM) presented with angina and an anterior ST-segment–elevation myocardial infarction (STEMI). Physical examination and chest x-ray were consistent with congestive heart failure. Admission glucose was 230 mg/dL. Coronary angiography revealed an occluded left anterior descending coronary artery, and stenting reestablished TIMI grade 2 flow in that artery within 90 minutes of symptom onset. Left ventricular ejection fraction was 35% with severe anterior hypokinesis. Peak creatine kinase was 600 IU. The next day, fasting glucose was 180 mg/dL. An echocardiogram performed 6 weeks after discharge revealed an ejection fraction of 35% without change in the anterior wall motion. Fasting glucose as an outpatient was 156 mg/dL. The scenario described above is commonly encountered and illustrates how hyperglycemia can affect the outcome of patients with STEMI. Hyperglycemia could have affected the following features of this case: (1) Congestive heart failure was present despite only modest myocardial injury by creatine kinase level; (2) despite successful percutaneous coronary intervention, subnormal coronary perfusion was observed; and (3) left ventricular recovery after STEMI did not occur. Cardiologists need to be cognizant of the hazards associated with hyperglycemia in this setting because these patients will be encountered more frequently as a result of the increasing prevalence of insulin resistance syndromes. Acute hyperglycemia is common in patients with STEMI even in the absence of a history of type 2 DM. Hyperglycemia is encountered in up to 50% of all STEMI patients, whereas previously diagnosed DM is present in only 20% to 25% of STEMI patients.1 The prevalence of type 2 DM or impaired glucose tolerance may be as high as 65% in MI patients without prior DM when oral glucose tolerance testing is performed.2 Elevated …

Nodular glomerulosclerosis in patients without any manifestation of diabetes mellitus

Diabetic nodular glomerulosclerosis is considered to be the specific renal lesion of diabetes mellitus (DM). However, some cases, in which nodular glomerulosclerosis was found without any manifestation of DM, have also occasionally been reported. We clinicopathologically examined seven cases without a prior history of DM. They consisted of six men and one woman with a mean age of 57 years, and included three cases with family history of DM and six cases with hypertension. Mean body mass index was 26.2 +/- 5.9 (means +/- SD) kg/m(2) and haemoglobin A1c 5.3 +/- 1.1% or haemoglobin A1 7.0 +/- 0.6%. Mean plasma glucose levels were 5.3 +/- 0.7 mmol/L at fasting and 10.1 +/- 1.9 mmol/L at 2 h of 75 g OGTT (normal: 1 patient; impaired glucose tolerance: 4 patients; DM: 2 patients). None of them showed diabetic retinopathy in fundoscopic ophthalmoscopy. Mean serum creatinine was 268 +/- 215 micromol/L, urinary protein 5.2 +/- 4.0 g/day, and three patients had mild haematuria. Renal biopsy revealed typical nodular glomerulosclerosis, a negative deposition based on an immunofluorescence study, and neither any significant electron dense deposits nor fibrils on electron microscopy. These patients at presentation had no overt clinical manifestations of glucose intolerance. Diabetic nodular glomerulosclerosis can occur in patients without overt DM, suggesting the role of factors additional to prolonged hyperglycaemia in the pathogenesis of this disorder.

398: Hyperglycemia and Acute Ischemic Stroke: Worse Outcomes in Patients with No Prior History of Diabetes Mellitus

To determine if differences in outcome exist between diabetic and non-diabetic patients who present to the emergency department with acute ischemic stoke and elevated blood glucose.

The Relationship of Plasma Glucose and HbA1c Levels among Emergency Department Patients with No Prior History of Diabetes Mellitus

The Relationship of Plasma Glucose and HbA1c Levels among Emergency Department Patients with No Prior History of Diabetes Mellitus

The Relationship of Plasma Glucose and HbA1c Levels among Emergency Department Patients with No Prior History of Diabetes Mellitus

Patients without a history of diabetes mellitus may be incidentally found to be hyperglycemic in the emergency department (ED). If the hyperglycemia is due to undiagnosed diabetes, then an opportunity for detection exists. Hemoglobin A1c (HbA1c) provides a weighted average of blood glucose levels over the past several months; high HbA1c levels could indicate diabetes. The objective of this study was to determine whether hyperglycemia in ED patients without a history of diabetes was associated with higher HbA1c levels. This was a prospective nonconsecutive case series of adults aged 18 years or older presenting to the ED with acute illness for whom a plasma glucose sample was drawn for clinical management. A history of diabetes/hyperglycemia or current symptoms of diabetes excluded patients. HbA1c levels were analyzed for a glucose cutoff of 110 mg/dL; the data were further analyzed using additional glucose cutoffs. Based on the Third National Health and Nutrition Examination Survey outpatient screening data, an HbA1c level > or =6.2% was considered elevated (sensitivity of 63% and specificity of 97% for identifying diabetes). There were 541 patients enrolled; the glucose level correlated with the HbA1c level (r = 0.60, p < 0.001). Among the 331 patients with a glucose level > or =110 mg/dL, 22.4% had an elevated HbA(1c) level; among the 210 patients with a glucose level < 110 mg/dL, 7.6% had an elevated HbA1c level. There were few patients (n = 13) with a glucose level > or =200 mg/dL, but most (85%) had an elevated HbA1c level. Among the 140 patients with a mildly elevated glucose level (110-125 mg/dL), 16.4% had an elevated HbA(1c) level. Elevated HbA1c levels are found in ED patients with elevated random plasma glucose values. ED patients with hyperglycemia may warrant referral for diabetes testing.

Is hyperglycemia a prognostic factor in pancreatic cancer?

14078 Background: Pancreatic hyperglycemia is one of the manifestations of pancreatic cancer.The purpose of this study is to explore the prevalence and significance of hyperglycemia at the time of diagnosis of pancreatic cancer. Methods: We reviewed retrospectively cases presenting to our institution with diagnosis of pancreatic carcinoma between 1999–2003. Hyperglycemia was defined as a blood sugar of greater than 140mg/dL. Results: There were 155 cases diagnosed with pancreatic cancer. Out of these, 67 (43.2%) were males and 71(45.8%) were females. The mean age was 63 years. Staging was reported in 134 patients: 19 patients (14%) were stage I, 23 (17%) stage II, 40 (30%) stage III and 52 (39%) stage IV. Median survival time was 8 months. Thirty-four (22%) patients had prior history of diabetes mellitus and were excluded from subsequent analysis. Sixty-four patients out of 121 patients (53%) were found to be hyperglycemic. These patients had no prior history of diabetes mellitus or were diagnosed with diabetes within six months. There was no difference between hyperglycemic patients and normoglycemic patients regarding age, sex, race, tumor location, smoking history, history of pancreatitis and hypertension. Hyperglycemic patients were more likely to have history of alcohol use compared to normoglycemic patients (p value = 0.005, OR = 4.07). Hyperglycemic patients were less likely to present with stage IV disease as compared to normoglycemic patients (25% vs. 55%) (p-value 0.002). The median survival in hyperglycemic patients was significantly longer than in normoglycemic patients (12 vs. 6 months, p-value = 0.02).There was a trend towards better survival among stage IV hyperglycemic patients as compared to normoglycemic patients (13 months vs 3 months) (p-value 0.38). Conclusions: In this retrospective analysis, 53% of pancreatic cancer patients without diabetes had hyperglycemia at presentation. These patients presented at an earlier stage compared to normoglycemic patients and had significantly longer survival. The impact of hyperglycemia on survival could be related to earlier presentation or difference in the tumor biology. The clinical significance of hyperglycemia in pancreatic cancer should be further studied in prospective fashion. No significant financial relationships to disclose.

Diabetes Mellitus and the Risk of Prostate Cancer

Background: Little is known about etiologic factors for prostate cancer. Several studies have suggested a protective effect of diabetes mellitus on the risk of prostate cancer, though a study by our group has found an elevated risk of prostate cancer following ischemic heart disease.Purpose: The purpose of this study was to investigate the association of diabetes mellitus with prostate cancer in the same setting in which we had found an elevated risk following ischemic heart disease. Our study differed from prior studies in utilizing a multi-racial population. Another purpose was to investigate stage-specific effects.Methods: We conducted a hospital-based case-control study in our University Medical Center in New York City. Cases were patients with prostate cancer seen at our Medical Center between January 1, 1984 and December 31, 1986. All cases were histologically diagnosed and had undergone a biopsy or surgical procedure at Columbia-Presbyterian Medical Center (CPMC). The controls were patients who underwent a surgical procedure for benign prostatic hypertrophy (BPH) during the same time frame and were not found to have prostate cancer. Prior history of diabetes was determined by review of the medical records. Logistic regression was used to assess the association between prior history of diabetes mellitus and prior history of prostate cancer.Results: We compared 320 cases to 189 controls, and found a lower risk for prostate cancer in diabetics overall (adjusted Odds Ratios (OR) 0.6, 95% Confidence Interval (CI) 0.3–1.1), though it was not statistically significant. No association was seen with Stage A prostate cancer, but there was a significant reduction in risk for stages B, C, and D combined (adjusted OR 0.47, 0.2–0.9). This effect appeared to be mainly concentrated among whites and Hispanics.Conclusions: Diabetics appear to have a lower risk of prostate cancer, though this effect may be limited to whites. An understanding of this association and its race specificity may help to explain the major difference in incidence rates for prostate cancer between blacks and whites.

Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus.

Although oligomenorrhea has been associated cross-sectionally with insulin resistance and glucose intolerance, it is not known whether oligomenorrhea is a marker for increased future risk of type 2 diabetes mellitus (DM). To prospectively assess risk of type 2 DM in women with a history of long or highly irregular menstrual cycles. The Nurses' Health Study II, a prospective observational cohort study. A total of 101 073 women who had no prior history of DM and who reported their usual menstrual cycle pattern at age 18 to 22 years on the baseline (1989) questionnaire. Incident reports of DM, with follow-up through 1997, compared among women categorized by menstrual cycle length (5 categories). During 564 333 person-years of follow-up, there were 507 cases of type 2 DM. Compared with women with a usual cycle length of 26 to 31 days (referent category) at age 18 to 22 years, the relative risk (RR) of type 2 DM among women with a menstrual cycle length that was 40 days or more or was too irregular to estimate was 2.08 (95% confidence interval [CI], 1.62-2.66), adjusting for body mass index at age 18 years and several other potential confounding variables. The RR of type 2 DM associated with long or highly irregular menstrual cycles was greater in obese women, but was also increased in nonobese women (at body mass indexes at age 18 years of <25, 25-29, and >/=30 kg/m, RRs were 1.67 [95% CI, 1.14-2.45], 1.74 [95% CI, 1.07-2.82], and 3.86 [95% CI, 2.33-6.38], respectively). Women with long or highly irregular menstrual cycles have a significantly increased risk for developing type 2 DM that is not completely explained by obesity.

HYPERGLYCEMIA IN PATIENTS UNDERGOING ELECTIVE CARDIOPULMONARY BYPASS PROCEDURES

Introduction: Patients undergoing procedures involving the use of cardiopulmonary bypass (CPB) are subjected to derangements causing hyperglycemia, even without exogenous glucose administration, which may contribute to postoperative morbidity from neurologic and renal dysfunction, infection, and poor wound healing. Blood glucose is routinely monitored at the following times: preoperatively, after induction of anesthesia, every 30 minutes while on CPB, after separation from CPB, and while in the intensive care unit. We have defined hyperglycemia as a serum glucose of >180 mg/dl, and persistent hyperglycemia as glucose >180 mg/dl on more than one measurement. We evaluated the incidence of hyperglycemia, risk factors for its development, and the incidence of insulin administration to maintain normoglycemia. Methods: During a 5 week period, 55 patients undergoing elective cardiac surgery utilizing CPB were monitored for development of hyperglycemia from the start of induction of anesthesia to the first 24 hours postoperatively in the intensive care unit. Presumptive factors which may increase the risk of developing hyperglycemia were recorded, including body mass index (BMI), preoperative diagnosis of diabetes, use of methylprednisolone, temperature on CPB of <32 degrees, CPB time, use of epinephrine, and use of inotropes other than epinephrine. Persistent hyperglycemia, insulin administration, and the requirement of an insulin infusion to maintain normoglycemia were also recorded. Data were analyzed by logistic regression. Results: Hyperglycemia occurred in 84%, and persistent hyperglycemia in 76% of patients. Prior history of diabetes, steroid administration, epinephrine, other inotropic support, temperature on CPB <32 degrees, CPB time, or BMI were not significant risk factors for hyperglycemia. The prevalence of diabetics in our patient population was 24%. Insulin was administered in 83% of patients who developed hyperglycemia, and an insulin infusion was used in 47% of the total patient population to maintain blood glucose below 180mg/dl. Conclusions: Hyperglycemia is a common occurrence; in patients undergoing elective cardiac surgical procedures utilizing CPB and requires insulin administration in the majority of cases. Prior history of diabetes mellitus, use of steroids, inotropic support, hypothermia, BMI, and CPB time were not significant risk factors.

Hypernatremia in diabetic ketoacidosis

AbstractThe elevated blood glucose in DKA creates an osmotic gradient which typically results in hyponatremia. Many patients present with elevated serum sodium concentrations in DKA and very little is known about these patients. We questioned if these patients represent a ‘sicker’ population than those with normal or low serum sodium concentrations.The objective of this study was to characterise those patients who develop elevated corrected serum sodium levels in diabetic ketoacidosis (DKA). A retrospective medical record review was done of all episodes of DKA at The Children's Hospital of Alabama between January 1992 and June 1994. All cases of DKA were in patients less than 17 years of age.Among the 79 study entries which consisted of 52 separate individuals 46% female (n=36) 54% male (n=43), 11 patients were admitted for more than one episode of DKA, 27% (n=21) were patients with new onset diabetes and 73% (n=58) were patients with a prior history of diabetes mellitus. Of the corrected serum concentrations of sodium, 85% (n=67) were less than 149 mmol/L. In the patients with corrected serum sodium concentrations greater than 149 mmol/L (n=12), 35% (n=4) were African‐American and 65% (n=8) Caucasian, which was representative of the overall study population race distribution. Sixty seven per cent (n=8) of the hypernatremic patients were male, 33% (n=4) female.Patients with new onset diabetes were more likely to present with elevated concentrations of sodium in serum than known diabetic patients (t=5.52, p=0.02); 33% (n=7) of the patients with new‐onset diabetes were hypernatremic. No association was found between corrected sodium and age (t=0.31, p=0.76), duration of symptoms (t=0.42, p=0.68) or serum urea nitrogen concentration which was used as a marker for level of hydration (t=1.48, p=0.14). Duration of symptoms was found to be longer among patients with new onset diabetes (ZT=4.31, p &lt; 0.001) and patients presenting with elevated serum concentration of sodium (ZT=2.20, p=0.028).We conclude that patients with new onset diabetes are more likely to present with elevated sodium values unrelated to age or level of hydration.

The Relationships Among Serum Uric Acid, Plasma Insulin, and Serum Lipoprotein Levels in Subjects with Spinal Cord Injury

Relationships were investigated among serum uric acid (UA), the insulin response to a standard oral glucose load (75 g), and serum lipoprotein levels in 197 individuals with chronic spinal cord injury (SCI). All subjects had normal liver and renal function. None had a prior history of diabetes mellitus or gout. The mean age of subjects was 50 +/- 1 years, duration of injury (DOI), 18 +/- 1 years, and body mass index (BMI), 25 +/- 0.4 kg/m2. No significant differences were found between those with paraplegia or quadriplegia for any of the parameters measured. The mean serum UA values were not significantly different among the subgroups of subjects with normal glucose tolerance, impaired glucose tolerance, or diabetes mellitus (5.6 +/- 0.2 mg/dl, 5.6 +/- 0.2 and 5.7 +/- 0.3, respectively). Approximately one-half of the subjects had an abnormality in oral glucose tolerance. The levels of serum UA (p < 0.001) and serum triglycerides (TG) (p < 0.01) in the subgroup with hyperinsulinemia were significantly higher than in the subgroup with normal insulin levels. By linear regression analyses, the serum UA concentration was positively correlated with peak plasma insulin level (r = 0.31, p < 0.001), and BMI (r = 0.20, p < 0.01), but not with age, DOI, or peak glucose. The data suggest that in subjects with chronic SCI, as in the healthy able-bodied population, hyperuricemia is associated with hyperinsulinemia, obesity and abnormal lipoprotein metabolism.

Diabetes mellitus and cancer risk: A multisite case-control study

The association between a prior diagnosis of diabetes mellitus and cancer was examined in a large multisite case-control study based on interviews of 8220 white males and 6690 white females aged 30–89 who were admitted to Roswell Park Memorial Institute between 1957 and 1965 for the diagnosis and treatment of cancer. A prior history of diabetes mellitus as diagnosed by a physician was examined as a risk factor for cancer by conducting sex- and site-specific comparisons with a common control group of 2363 white males and 2475 white females who were admitted to the same hospital during the same years, but were found not to have cancer.The findings are consistent with previous studies which have shown diabetes to be a risk factor for cancer of the uterine corpus. A positive association was also noted between diabetes and cancer of the vulva and vagina. The evidence for excess estrogen levels as the underlying mechanism for increased risk of uterine and vulvo-vaginal cancer is reviewed. No consistent association between diabetes and pancreatic cancer was observed in this study, except when those cases in which diabetes was diagnosed within a year before the diagnosis of pancreatic cancer were included. This suggests that diabetes may be an early presenting sign of pancreatic cancer rather than a risk factor.A positive association between prior diagnosis of diabetes was noted for kidney cancer and nonmelanoma skin cancer in females only. No association between type of treatment (i.e. insulin, oral agents) and cancer risk was noted.