Endocrinology
Is higher blood sugar linked to getting or dying of cancer?
Open access · cc by · source: Europe PMC
People with higher blood sugar were more likely to develop cancer and especially to die from it, and this held even within the upper-normal range in women.
Study at a glance
- Design
- Cohort — Pooled analysis of six population-based cohorts from Norway, Austria and Sweden linked to national cancer and death registers; Cox regression with correction for measurement error using repeated glucose tests.
- N
- N=549944 · 549,944 people (274,126 men and 275,818 women) in the final dataset; the regression dilution correction used repeat measurements from 133,820 individuals.
- Population
- Adults attending health examinations in Norwegian, Austrian and Swedish population cohorts, mean age about 45, without cancer at baseline.
- Outcome
- Incident cancer and fatal cancer overall and by site, plus all-cause mortality, over roughly 10 years of follow-up.
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Key findings
Each 1 mmol/l increase in glucose was linked to a 5% higher risk of new cancer and 15% higher risk of cancer death in men, and 11% and 21% higher risks in women. Women in the top tenth of glucose had about twice the risk of fatal cancer compared with those in the lowest 40%, and men in the top tenth had a similar rise (1.84 times). Associations were seen for several specific cancers, such as liver, gallbladder and respiratory tract in men and pancreas and stomach in women, but not prostate cancer. The relationship looked roughly linear, and correcting for measurement error made the fatal-cancer excess risk about four times larger than the uncorrected estimate.
Methodology
The researchers pooled health-check data from 549,944 adults in six cohorts in Norway, Austria and Sweden and followed them through national registers for new cancers and cancer deaths. They related blood glucose at the first health examination to cancer risk, adjusting for age, body mass index and smoking and starting follow-up one year after the blood test. Because a single glucose test is noisy, they used repeated measurements in 133,820 people to correct the risk estimates for this random error.
Limitations
This is observational, so glucose may be a marker for other factors such as alcohol, diet or physical activity that were not measured; only BMI and smoking were adjusted for. Glucose was measured differently across cohorts, with varying fasting times, so absolute glucose cut-offs cannot be applied directly. The stronger link with cancer death than diagnosis could reflect later diagnosis or coding differences rather than biology. Many site-specific tests were run, so some individual findings, such as lower thyroid cancer risk in women, may be chance.
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