Cancer, Not Vascular Diseases, No. 1 Cause of Death in Patients With Diabetes

As vascular-related deaths have declined among patients with diabetes, they are no longer the leading cause of death in this population: cancer is, according to a UK study.

“Improvements in risk factors such as smoking and blood pressure, along with progress in medical treatments have contributed to large falls in deaths from heart disease and stroke. The improvements have been even greater in those with diabetes. This has resulted in vascular conditions accounting for around 25 per cent of all deaths in those with diabetes compared to 45 per cent 20 years ago, ” said lead study author Dr. Jonathan Pearson-Stuttard in a press release.

“In contrast, improvements in cancer death rates have been much more modest, with improvements in those with diabetes lagging behind the general population. It is striking that cancer is now the leading cause of death in England among people with diabetes and the leading contributor to excess death compared to those without diabetes. Added to this is the fact the UK continues to lag behind other EU countries in terms of cancer survival rates.”

The prevalence of diabetes has been on the rise in the UK and other high-income countries, Dr. Pearson-Stuttard and his fellow authors noted. In the United States, it’s increasing “at an alarming rate,” according to the Diabetes Research Institute Foundation.

For the study, the authors identified 313,907 patients with diabetes using the Clinical Practice Research Datalink primary care database for data spanning 2001 through 2018 and linked the data to UK Office for National Statistics mortality data. Patients with diabetes were age- and sex- matched 1:1 to patients without diabetes identified from the same dataset, and estimates were made on their mortality rates.

Total mortality in patients with diabetes declined by about a third from Jan. 1, 2001, through Oct. 31, 2018, in both men (32%) and women (31%); over the study period, death rates declined from 40.7 deaths per 1,000 person-years to 27.8 deaths in men with diabetes, and from 42.7 deaths to 29.5 deaths in women with diabetes. Trends were similar among patients without diabetes, so the mortality gap between the two groups persisted.

Of the 12 cause of death groups measured, cause-specific death declined in 10 of them; the two exceptions were dementia and liver disease. The decline in vascular disease deaths was so significant that cancer overtook it as the leading cause of death in patients with diabetes.

Senior study author Professor Anthony Gregg said of the findings, “This study is another reminder that as people die less from cardiovascular diseases, diabetes still leads to a wide range of other problems. The diversification of the big contributors to death here included cancers, dementia and respiratory diseases. This, and the current experience with COVID-19, is a reminder that we need to take an increasingly broad view about what prevention means for people with diabetes.”

The study was published in The Lancet Diabetes & Endocrinology.