Cancer Leads Causes of Death Among People With Diabetes

Diabetes is associated with increased risk of vascular conditions, such as ischemic heart disease, stroke, renal, and neuropathic complications. In this featured study, researchers examine how the cause of mortality in diabetes has changed over time.

Among individuals in the United Kingdom with diabetes, cancer is the leading cause of diabetes-related death. This is according to research results published in Lancet Diabetes and Endocrinology.

Within the United Kingdom, few studies have examined trends in specific causes of death, meaning that the understanding of diabetes-related mortality is poorly understood. In order to address this, researchers conducted an epidemiological analysis to estimate how mortality in diabetes has changed over time, how the composition of this mortality burden has changed, and how it is compared with the population living without diabetes.

Data were collected from the Clinical Practice Research Datalink (CPRD) GOLD from 2001 to 2018. The CPRD is a primary care database including pseudo-anonymized data of 45 million patients from 674 practices across England, representing 7% of the population.

Data were extracted from records of patients with diabetes (n=313,907), then assembled into serial cross sections with longitudinal follow-up. Patients with diabetes were age- and sex-matched 1:1 with patients without diabetes.

Over the course of the study period, all-cause death rates declined in people with and without diabetes; all-cause death rates declined by 32% and 31% in men and women with diabetes, and by 41% and 33% in men and women without diabetes. During this period, the absolute gap in death rates was maintained.

Within a list of 12 specified causes, death rate per year was higher among people with diabetes compared with those without across the study period, excluding dementia for both sexes and injuries for men in 2001.

The largest absolute decline in specific causes of death was noted in ischemic heart disease, stroke, and diabetes; similar improvements were noted in both men and women, and similar patterns were observed in the non-diabetes population. Conversely, death rates due to dementia and liver disease increased throughout the study period.

In 2018, the largest diabetes-related gap in death rates between the two groups was in the categories of other cancers, dementia, diabetes-associated cancers, and respiratory deaths; researchers noted “much reduced” gaps in ischemic heart disease and stroke. Per researchers, this finding was “driven by a combination of a major reduction in vascular disease mortality in the diabetes population, with declines greater than in the non-diabetes population.”

The proportion of death resulting from vascular disease declined from 44% to 24% between 2001 and 2008 in those with diabetes with a similar reduction (43% to 25%) was seen in the non-diabetes group. Cancer-related deaths increased from 22% to 28% in the diabetes group, and from 24% to 27% in the non-diabetes group. Diabetes-related cancers specifically were attributable to nearly 50% more mortality burden in the diabetes group, compared with those without diabetes.

Study limitations include those inherent to epidemiological analyses, including miscoding, misdiagnosis, and misclassification, a lack of stratification by diabetes type, and missing data in the dataset.

“The large declines in all-cause…and vascular disease death rates have led to cancer being the leading contributor to the gap in death rates between those with and without diabetes,” the researchers concluded. “Further longevity gains and reducing the gap between individuals with and without diabetes will require a shift in clinical and preventive approaches to encompass the wider set of disease risks.” 

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Pearson-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(3):165-173.