In this study, partly funded by the British Heart Foundation, hazard ratios were calculated for cause-specific death, according to baseline diabetes status or fasting glucose level, from individual-participant data on 123,205 deaths among 820,900 people in 97 prospective studies.

• After adjustment for age, sex, smoking status, and body-mass index, hazard ratios among persons with diabetes as compared with persons without diabetes were as follows:

o 1.80 (95% CI, 1.71 to 1.90) for death from any cause
o 1.25 (1.19 to 1.31) for death from cancer
o 2.32 (2.11 to 2.56) for death from vascular causes
o 1.73 (1.62 to 1.85) for death from other causes

• Diabetes (vs. no diabetes) was moderately associated with death from cancers of the liver, pancreas, ovary, colon-rectum, lung, bladder, and breast.

• Aside from cancer and vascular disease, diabetes (vs. no diabetes) was also associated with death from renal disease, liver disease, pneumonia and other infectious diseases, mental disorders, non-hepatic digestive diseases, external causes, intentional self-harm, nervous-system disorders, and chronic obstructive pulmonary disease.

• Hazard ratios were appreciably reduced after further adjustment for glycaemia measures, but not after adjustment for systolic blood pressure, lipid levels, inflammation or renal markers.

• Fasting glucose levels exceeding 5.6 mmol/l but not levels of 3.9-5.6 mmol/l were associated with death.

• A 50-year-old with diabetes died, on average, 6 years earlier than a counterpart without diabetes, with about 40% of the difference in survival attributable to excess nonvascular deaths.

The researchers conclude from these findings that “in addition to vascular disease, diabetes is associated with substantial premature death from several cancers, infectious diseases, external causes, intentional selfharm, and degenerative disorders, independent of several major risk factors.” They stress the need to better understand and prevent the multisystem consequences of diabetes.