Diabetes mellitus is a serious and costly disease that is becoming increasingly common in many countries, including Korea, the site of this study, according to background information in the article. Recent data show that approximately 150 million people have diabetes mellitus worldwide, and this number may double by 2025, especially in developing countries, because of population growth, aging, unhealthy diets, obesity, and sedentary lifestyles.

Sun Ha Jee, Ph.D., M.H.S., of the Graduate School of Public Health, Yonsei University, Seoul, Korea, and colleagues examined the relationship between fasting serum glucose and diabetes and risk of all cancers and specific cancers in men and women in Korea. The 10 year Korean Cancer Prevention Study (KCPS) included 1,298,385 Koreans (829,770 men and 468,615 women) aged 30 to 95 years who received health insurance from the National Health Insurance Corp. and had a biennial medical evaluation in 1992-1995.

During the 10 years of follow-up, there were 20,566 cancer deaths in men and 5,907 cancer deaths in women. The researchers found that, while controlling for smoking and alcohol use, the group with the highest fasting serum glucose (140 mg/dL or greater [7.8 mmol/L or greater]) had a higher death rates from all cancers combined (29 percent higher for men; 23 percent higher for women) compared with the group with the lowest level (less than 90 mg/dL [less than 5.0 mmol/L]). By cancer site, the association was strongest for pancreatic cancer, comparing the highest and lowest stratums (91 percent increased risk in men; more than twice the risk for women). Significant associations were also found for cancers of the esophagus, liver, and colon/rectum in men and of the liver and cervix in women, and there were significant trends with glucose level for cancers of the esophagus, colon/rectum, liver, pancreas, and bile duct in men and of the liver and pancreas in women.

Of the 26,473 total cancer deaths in men and women, 848 were estimated as attributable to having a fasting serum glucose level of more than 90/mg/dL. For cancer incidence, the general patterns reflected those found for mortality. For persons with a diagnosis of diabetes or a fasting serum glucose level greater than 125 mg/dL (6.9 mmol/L), risks for cancer incidence and mortality were generally elevated compared with those without diabetes.

"While the generalizability of the findings is uncertain, we have shown that fasting serum glucose level and diabetes are associated with cancer risk in a population far leaner than the Western populations in other studies. These associations do not reflect confounding by obesity, suggesting that the mechanism of increased cancer risk reflects the consequences of hyperinsulinemia. Glucose intolerance may be one pathway by which obesity increases cancer risk, and rising obesity may increase future cancer rates," the authors write.

(JAMA. 2005;293:194-202. Available post-embargo at jama.com)

Editor's Note: This study was funded by a grant from the National Cancer Institute.

Note: If no author is given, the source is cited instead.

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